Australasiaâ€™s First and Only eHealth and Health IT Magazine
17 FEBRUARY 2014
TELEHEALTH & ATC 2014 PREVIEW The promise of telehealth
The telehealth model in primary care was shot in the foot when limitations were applied to providers. Can its promise be resurrected?
While low-tech works effectively for everyday video consults, some experts are taking a high-tech route for the aged care sector.
Building the telehealth future Seven leading health organisations will come together to highlight seven big topics in telehealth at the Australian Telehealth Conference in March.
Organisations please note: The Pulse+IT eNewsletter service has expanded, with each day of the week now focused on a different part of the health sector. Aged care, allied health, medical practices and the acute sector all receive dedicated coverage, with targeted advertising opportunities for 2014 now available. To register your interest and obtain a media kit, email: email@example.com
Want to keep your finger on the pulse? Pulse+ITâ€™s companion eNewsletter service is the sectorâ€™s most trusted source of timely eHealth and Health IT news. Pulse+IT eNewsletters bring together breaking news, events, career and business opportunities, webinars and software training sessions, keeping readers informed and up to date. Our rapidly growing list of over 10,200 subscribers enjoys:
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Looking Ahead Pulse+IT welcomes feature articles and guest editorial submissions relating to the nominated edition themes, as well as articles relating to eHealth and Health IT more broadly. In addition to our daily eNewsletter service, Pulse+IT is produced in print seven times per year with the remaining six editions for 2014 to be distributed for release in: • April 2014 - National eHealth agenda • Mid-May 2014 - Aged care • July 2014 - Hospitals • Mid-August 2014 - Practices • October 2014 - New Zealand • Mid-November 2014 - mHealth and devices Submission guidelines and deadlines are available online: http://www.pulseitmagazine.com.au/editorial Pulse+IT acknowledges the support of the following organisations, each of whom supply copies of Pulse+IT to their members.
About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With an international distribution exceeding 35,000 copies, it is also one of the highest circulating health publications in Australasia. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 5,000 copies of Pulse+IT are distributed to health information managers, health informaticians, and IT decision makers in hospitals, day surgeries and aged care facilities. ISSN: 1835-1522 Contributors Dr James Freeman, Samuel Holt, Simon James, Dr George Margelis, Kate McDonald and Dr Victoria Wade. Disclaimer The views contained herein are not necessarily the views of Pulse+IT Magazine or its staff. The content of any advertising or promotional material contained herein is not endorsed by the publisher. While care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information herein, or any consequences arising from it. Pulse+IT Magazine has no affiliation with any organisation, including, but not limited to Health Services Australia, Sony, Health Scope, the New Zealand College of General Practitioners, the Rural Doctors Association of Australia, or the Kimberley Aboriginal Medical Services Council, all who produce publications that include the word “Pulse” in their titles. Copyright 2014 Pulse+IT Magazine Pty Ltd No part of this publication may be reproduced, stored electronically or transmitted in any form by any means without the prior written permission of the Publisher. Subscription Rates Please visit our website for more information about subscribing to Pulse+IT.
TELSTRA TEAMS UP WITH DR FOSTER
E-HEALTH BLUEPRINT FOR NSW
HIGH-TECH TELEHEALTH FOR THE AGED
012 014 036
Simon James introduces the first edition of Pulse+IT for 2014.
Has eHealth and telehealth in Australia delivered on its promise? In many respects, the answer is no.
JAMES FREEMAN By limiting access to telehealth, we have in effect rationed Medicare.
SELECTED BITS & BYTES Majority of public hospitals uploading discharge summaries to PCEHR this year Dr Foster now on offer as Telstra moves into acute care Best Practice and Zedmed integrate with Tyro and NPDR Dr Info trials patient info look-up with after-hours GP service
SATELLITE AND LATENCY
TELEHEALTH BY BROWSER
SIMPLE TECHNOLOGY AT HOME
DIALYSIS AT HOME
HANDOVER BY TELEHEALTH
SAM HOLT Technology itself is no longer a barrier for most telehealth services, but a sustainable model is.
TORI WADE Technology isn’t enough, so how can telehealth be boosted?
NSW creates eHealth strategy for rural and remote areas Mobile app to help GPs help patients in pain WentWest links LinkedEHR care planning to HealthPathways portal DocAppointments launches repeat script request function
EVENTS Up and coming eHealth, Health, and IT events.
The San goes live with AMT for drug allergies
AutumnCare to let GPs connect for medications profile
The Pulse+IT Directory profiles Australasia’s most innovative and influential eHealth and Health IT organisations.
NSW takes a federated approach with $400m eHealth blueprint
TELEHEALTH FOR THE FUTURE Pulse+IT previews the Australian Telehealth Conference (ATC 2014) in Melbourne next month.
Providing telehealth to remote areas is reliant on understanding the limitations of satellite.
GP2U is now using WebRTC to conduct video conferences through the desktop and by tablet or phone.
Flinders Uni is trialling the use of consumer tech like iPads and Fitbit for telehealth in the home.
Queensland’s Centre for Online Health has launched RES-e-CARE to provide telehealth to aged care.
Western Health is trialling remote monitoring and video conferencing to improve rates of home dialysis.
A Victorian Medicare Local is hoping to develop an oncology handover clinic for patients and GPs.
WHAT THE PCEHR DID NEXT With the PCEHR launching for consumer registrations in July 2012, and with general practices interested in maintaining their eHealth Practice Incentives Program eligibility required to install the system in the first half of 2013, the new government’s review into the system attracted a great deal of attention, with speculation about the future of the PCEHR ongoing.
SIMON JAMES BIT, BComm Editor: Pulse+IT email@example.com
With the then-Opposition sending the odd barb out about excessive spending for little return, it came as no surprise that incoming Health Minister Peter Dutton wasted little time in calling for a review into the former government’s flagship eHealth initiative, the PCEHR system.
just six weeks thereafter and very much on the eve of the festive season.
The review, announced on November 3, was headed up by UnitingCare Queensland executive director Richard Royle, with AMA president Steve Hambleton and Australia Post CIO Andrew Walduck making up the balance of the review panel.
Despite imposing a requirement that organisations making submissions to the review process refrain from publishing their contributions before Mr Dutton’s response, many organisations have released their recommendations via their own websites and various media channels.
In announcing the process, Mr Dutton offered some of his own perspectives, saying that a year after the introduction of the electronic health records system “only a fraction of Australians have established a record and for those who have, only a few hundred doctors have added a shared health summary.
About the author Simon James is the editor of Pulse+IT, one of Australia’s highest circulating health publications of any kind. Prior to founding the publication in 2006 he worked in an IT support capacity for various medical practices, and subsequently for both clinical software and secure messaging developers.
“This defeats the purpose of having a national, electronic system that is meant to help save lives. The government fully supports the concept of electronic health records but it must be fit for purpose and cost effective.” The deadline for submissions to the PCEHR review panel was a short three weeks after the process was announced, with the panel reporting back to Mr Dutton
At the time of writing, Mr Dutton has not made public his response to the review process, nor released the report submitted by the review panel to his office.
Throughout November, December and January, Pulse+IT took the opportunity to compile a list of links to submissions that have emerged to date – available as a perpetual resource on the Pulse+IT website – with many of these submissions attracting strong interest and associated news reporting. In fact, some of Pulse+IT’s reporting on the public submissions were amongst our most popular stories for the year. The AMA and the Consumers Health Forum made for interesting bed-fellows, with both organisations calling for the PCEHR to migrate to an opt‑out system, a move that would dramatically reduce complexity for both patients and their healthcare providers, while simultaneously
reducing the costs associated with enrolling consumers into the system.
future direction of the PCEHR and other eHealth initiatives.
The RACGP, on the other hand, called for an immediate end to the addition of new functionality so that the system could be re-evaluated and an emphasis placed on clinical utility at the point of care. ACRRM, meanwhile, took the opportunity to highlight some of the rent‑seeking behaviour that has been associated with sponsored advocacy for the PCEHR.
Dr Hambleton has previously told Pulse+IT that the AMA wanted to make sure that clinicians had confidence in the information held within the system, “that it is up to date and the most recent health summary is indeed the most recent health summary, making it clinically useful”.
While understood to have been appointed to the review panel with the expectation of acting at arms’ length to his duties as AMA president, Dr Hambleton’s inclusion on the panel was nevertheless significant, perhaps indicating that the peak doctors’ body may enjoy more influence over the
Speaking to ABC Radio following the launch of the PCEHR review, Dr Hambleton suggested that the biggest stumbling block with the system was its strategic direction.
“If we can decrease the search time for information, that will make people interested. If we can make it easy to interface with it, with the right software … we can help with the efficiency of the health system and that’s the real driver. We absolutely need to get this right.” With further details about the direction of the PCEHR expected to emerge in the coming weeks, the April edition of Pulse+IT will be dedicated to both the shared health records system and the broader national eHealth agenda.
19 - 20 MARCH
“Unless there is more than a critical mass of accurate, accessible, clinically relevant information there can be no clinical use,” he said.
“We need to refocus this on efficiency, to simplify everybody’s lives,” he said. “At the moment the focus has been on adding on products to the PCEHR, none of which is going to drive people to use it.
Leadership and action for the delivery of CONFERENCE
telehealth in Australia
Building for the Future
register for atc today to ensure unparalleled accesss to australia’s most concentrated forum of telehealth experts
one united voice.
this is australia’s telehealth conference.
E-HEALTH, TELEHEALTH AND
OVERCOMING THE HYPE CYCLE As we enter 2014, we look back at the last decade or two of eHealth and telehealth in Australia and around the world to see whether it has delivered on its promise. Unfortunately, in many respects the answer is no. This year, we need to find a common goal upon which doctors, technologists, payers and patients agree.
DR GEORGE MARGELIS MBBS, M.Optom GCEBus University of Western Sydney firstname.lastname@example.org
Many of us remember futuristic videos from the turn of the century that showed paperless hospitals, seamless transitions between healthcare providers of complex patients, and the promise of huge improvements in efficiency. We saw images of patients being treated in the comfort of their own home, whilst the doctor used his smart phone on the golf course to diagnose a patient, and then went back and completed his putt. There was even the promise of saving billions of dollars, and a reversal in the trend of increasing healthcare budgets. Some 50 years after the introduction of the first EMR into a hospital, we still see limited uptake, huge cost over-runs in implementations, scant evidence of real clinical value, and limited if any effect on healthcare costs. Patients still line up in busy waiting rooms, and doctors’ golf games are still cut short by the need to save lives in person. Based on this, we have to ask: what has gone wrong?
About the author Dr George Margelis is a medical doctor and health informatician. He is an adjunct associate professor at the TeleHealth Research & Innovation Laboratory (THRIL) at the University of Western Sydney.
Gartner is famous for developing the “hype cycle”, a graphical tool for representing the maturity, adoption and social application of specific technologies1. It demonstrates the hyperbolic rise is expectations of new technologies followed by the crash as they descend to the “trough of disillusionment”, followed by a teasing out of which technologies actually work to reach a plateau of productivity.
Whilst there has been some criticism of the model, it remains uncannily predictive of the cycle of technologies in many areas, including health. The largest variable in the model remains the timeline. Whilst in the consumer space it has been compressed recently to be measured in months, in areas like health it often seems the measurements are in decades. Many contend that this corresponds to the long time-cycles experienced in healthcare in all facets2. Whilst the authors of that paper postulate that innovations in healthcare delivery take on average 17 years to be implemented in practice, in eHealth it seems that the cycle is even longer. To be fair, we need to reflect that too often this cycle is compared to consumer technologies that have few if any safety implications. Whilst I still cringe at comparisons between banking, retail, manufacturing and healthcare, which tend to suggest that healthcare is run by a bunch of Luddites, we cannot deny that for us ”older” practitioners, the promised value has been “around the corner” for far too long.
The promise of eHealth In 2013, the RAND corporation published an interesting op ed piece on “The Delayed Promise of Health-Care IT”3. To put this in context, in 2005 RAND published a series of documents, including a seminal article
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“In eHealth, it would appear that we tend to be more akin to inhabitants of Mercury and Pluto: very widely separated and at risk of one of the groups being reclassified at less than full planetary status.” Dr George Margelis
in the respected journal Health Affairs4 suggesting that the value of eHealth should be measured in the hundreds of billions of dollars. This became the basis for significant investment in many countries on eHealth systems. In contrast, we see the UK and Australia more recently commission reports on why our eHealth systems have not delivered on their promise. The National Audit Office in the UK published a report in 2011 which stated that “progress with delivery of care records system continues to fall well below expectation”5 but also highlights “the money spent to date has not been wasted and will potentially deliver value for money”. At this stage we still await the Australian report on the PCEHR.
stated, replace doctors with technology because “healthcare is like witchcraft and just based on tradition”7? I remain the optimist, although I must admit my exuberance of a decade or so ago has been diluted by reality. There remains in eHealth a dichotomy between those who develop and sell systems and those who deliver healthcare that we continue to struggle to come to terms with. The “irrational exuberance” of the technologists, with their desire to preach disruption as the new paradigm versus those trained in clinical science who see change as a sign of disease in their human patients and extrapolate that to the healthcare system, continues unabated.
In the US, the good folk from RAND reset expectations with another article in Health Affairs in 2013 on “What It Will Take to Achieve the As-Yet-Unfulfilled Promises of Health Information Technology”6.
Predictions of transformations versus on-the-ground experience of “more of the same” need to be correlated. However, we cannot do this whilst we continue to live in our own little worlds.
With the advent of the doomsayers in eHealth, do we need to reset our expectations, and potentially write off billions in investment? What would the consequences be of such actions? Is healthcare really full of Luddites who can’t comprehend the value of technology due to their own petty financial and social constraints? Should we, as noted Silicon Valley entrepreneur Vinod Khosla recently
Planetary differences In his famous book on gender differences, John Gray described men as being from Mars while women are from Venus. Some years ago, Professor Steven Boyages said the same thing about clinicians and managers. In eHealth, it would appear that we tend to be more akin to inhabitants of Mercury and Pluto: very widely separated
and at risk of one of the groups being reclassified at less than full planetary status. We see academic centres for eHealth and healthcare being delivered from totally different faculties, often with conflicting goals, and fighting over the same limited research dollar. We see large projects funded to demonstrate the value of new technologies in isolation from the needs of healthcare providers. Failure of goal-setting in a clinically relevant way, a fascination with savings despite the stark reality that our healthcare system is insufficiently funded to succeed, and a strong desire to point to villains in the other camp as the cause of our problems remain as major impediments. To overcome this, better education of our healthcare practitioners of the basics of informatics, and the education of our technologists of the basics of healthcare delivery, is critical. Ensuring that the payers and associated bureaucracies are on the same page is also critical. Governments and insurers play a critical role in enabling or stifling progress in healthcare delivery. Policy drives change in healthcare in Australia, and it needs a longer term focus than just a single election cycle to deliver real value. Telehealth is a good example of how failure to set common goals across all the stakeholders has led to despair. The promise of obtaining high-quality care at home is very enticing for many patients. For many doctors it is also a great way to use their skills for a wider audience, and even supplement their income. For payers, it was hoped it would be a way of saving money. In reality, in classical supply-demand economics, it just increased the demand for services which led to more rather than fewer costs. In a knee-jerk reaction, limitations were put on the eligibility for reimbursement, which
led to decreased demand and a collapse of the supply side. Rather than re-examining how it is paid for and taking into account its differences to classical care models, they just cut the demand for it by limiting its availability and effectively shot a nascent care model in the foot.
Sweet spot of real value Returning the focus to the patient rather than to the industry groups or political parties involved should be the goal. This has to be more than rhetoric, and also has to be more than political point-scoring for all involved. Just embracing the patient isn’t the same as empowering them. They too need to be part of the educational process, but we need to be realistic about the pace with which this can be achieved. Whilst there are many shining examples of the empowered patient – my friend e-Patient Dave, who is coming down under later this year, is a good example – the bulk of healthcare demand is still from patients who haven’t been converted to full empowerment yet. For these
people, clinicians are obliged to take on responsibility for ensuring their care. Technologists are focused on capturing vast quantities of data from them, and delivering it in various “big data” scenarios, whilst doctors tend to focus on the detail of getting them through their current crisis to their next. Payers and policy makers are focused on capping the cost and squeezing it into a predefined budget. Somewhere in between we need to find a common goal with which the doctors, technologists, payers and most importantly the patients will agree is the “sweet spot” of real value. This will require real discussion between parties on an equal footing. It is far too important to become a political hot potato to be used by warring factions in parliament, but needs to evolve to a robust and mature discussion at a societal level. Education is one of the key requirements to enable this, along with honesty and empathy. I hope 2014 is the year we can move to this discussion.
References 1. www.en.wikipedia.org/wiki/Hype_cycle accessed January 13 2014. 2. Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics 2000. 3. www.rand.org/blog/2013/02/thedelayed-promise-of-health-care-it. html accessed January 13 2014. 4. Hillestad R, Bigelow J, et al. Can Electronic Medical Records Transform Health Care? Health Affairs September 2005 p1103-1117. 5. National Audit Office. The National Programme for IT in the NHS: an update on the delivery of detailed care records systems. May 2011 6. Kellerman AL, Jones SS. What It Will Take to Achieve the As-Yet-Unfulfilled Promises of Health Information Technology. Health Affairs January 2013 pp63-68. 7. www.thehealthcare blog.com/ blog/2013/08/31/vinod-khoslatechnology-will-replace-80-percent-ofdocs/ accessed January 13 2014.
HELP END HEALTH SERVICE RATIONING Telehealth is a secure, reliable and convenient way to deliver care to people who might otherwise not receive it. However, by limiting access to Medicare-funded telehealth, Australia has for the first time in effect rationed Medicare. It is an injustice that our ‘universal’ healthcare system limits who can receive care.
DR JAMES FREEMAN BSc MBBS Founder, GP2U email@example.com
Every day we see examples of a healthcare system under stress, a system that is crying out for innovation. Prolonged waiting times in emergency departments, GPs closing their books to new patients, and increasingly long specialist waiting lists represent only the tip of a very large iceberg. We’re struggling to meet demand. Thankfully, we are finally starting to see change. The Australian health system is evolving to meet the challenges, and new technologies offer innovative and exciting opportunities for the medical profession to deliver care in more efficient and patientcentric ways. One such innovation is telehealth. This service allows doctors to see their patients via the Internet using video conferencing and other technologies. All that’s required is access to a computer, tablet or smartphone with a good Internet connection.
About the author Dr James Freeman is the founder and executive director of GP2U, with responsibilities for platform development and clinical oversight. He is also a practising GP in Tasmania. He has a long interest in the remote delivery of healthcare and all things medical, engineering and IT.
The surge in computer literacy over the last 10 years, along with the structural changes associated with the limited inclusion of telehealth in the MBS in July 2011, has led to a rising wave of interest in telehealth. This demand has come from both rural and urban communities looking for essential consultations or time-poor
patients unable to access regular health services. Where telehealth may have once been seen as impractical, it is now increasingly seen as secure, reliable and convenient. Online consultation platforms now extend specialist-only telehealth services to GPs, and provide a mechanism for any Australian GP to deliver telehealth care to any patient. It is, by its very nature, an inclusive, not an exclusive system.
Medicare rationing Sadly, the Medicare funding model put in place by the previous government is not inclusive. It is in fact the first instance of major Medicare rationing we have seen in Australia. I ask these three questions: How is it possible to say a specialist doctor can deliver a useful service to patients (and will receive Medicare funding for doing so) but that a GP cannot also deliver useful services? Why is it that a patient on one side of an arbitrary geographic boundary can be eligible but their neighbour ineligible to receive Medicare-funded care? Why is a patient in a residential aged care facility eligible but a similar patient in home care ineligible?
This is exactly what the MBS currently says. It is neither just nor equitable and strikes at the very foundations upon which Medicare was built. Why are we rationing patient care to those who need it most?
all, the bedrock of our healthcare system. If we really want telehealth to find its wings, GPs must be included.
While there are around 20 million specialist consultations a year, there are over 120 million GP consults, so it’s quite clear GPs carry the bulk of the workload. If telehealth is really going to deliver all the promised benefits, it makes little sense to limit service delivery to less than 15 per cent of all medical consultations. If you take the geographic limitations into account, only about five per cent of the annual volume of medical consults are currently MBS telehealth eligible.
Telehealth will never replace the need for face to face consultations, but it carries with it some real advantages.
It is, in my view, a great injustice that our ‘universal’ healthcare system limits who can receive Medicare-funded telehealth. I am not alone in holding this view. The RACGP has in its last two annual prebudget submissions appealed for GPs to be placed squarely in the forefront of telehealth and patient care – they are, after
With home visits on the decline, virtual visits by video conference offer a real and viable alternative. We see patients being less guarded and more open in their communications via video conference than might typically be expected face to face. This has major advantages in terms of getting “the real story”.
Continuity of care
Telehealth is a very practical mechanism for a doctor to establish the patient’s history. If a patient seeks a consultation from within their home, it’s actually a far more effective mechanism of establishing that patient’s social context than a consultation that takes place within a GP surgery.
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Telehealth neither mandates nor precludes continuity of care. Doctors are free to offer appointments and patients can search for clinicians by a number of criteria. This presents the unique opportunity for patients to find a clinician ideally suited to their particular needs. Similarly, doctors retain complete choice about what care they choose to deliver via telehealth. I believe the focus on specialist care by the Medicare system needs to change. For too long, the contribution of Australian GPs to public health and wellbeing has played second fiddle to increasingly complex and expensive acute care. There are 50,000 GPs in Australia delivering six times the volume of patient services that our 25,000 specialists currently provide. The potential rewards to our health system are just too great to ignore. GPs perform hundreds of medical consultations each week to patients asking for nothing more than to have the same access to care as every other Australian. I say we give it to them.
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THE BUSINESS OF ONLINE CARE Technology itself is no longer a barrier for the vast majority of telehealth services in Australia. What remains a barrier is the many issues faced when scaling telehealth services up to a sustainable model. By factoring the true costs of telehealth, you will be able to create a telehealth model that will meet the needs of your practice and your patients.
SAMUEL HOLT firstname.lastname@example.org Director of Online Care, Anywhere Healthcare
The real challenge in telehealth today isn’t technology. It was telehealth early adopters who had to battle through third world-like internet connectivity, expensive hardware-based solutions, a lack of industry standards, a relatively non-existent funding stream and a wall of health industry resistance. Today, we are spoiled for choice when it comes to technology. Inexpensive and free, web-based video conferencing solutions abound, some of which are even interoperable. Broadband and 4G internet is now widely available throughout the country and some parts have access to the NBN. There is a funding stream, via Medicare, that has enabled telehealth to climb out of the closet and into the mainstream, whilst the RACGP and many specialist colleges have created technical and clinical standards to assist clinicians with delivering care online efficaciously.
About the author Sam Holt is the director of online care with Anywhere Healthcare, part of Medibank Health Solutions, which runs an online-only practice with a growing panel of over 30 specialists who provide dedicated telehealth sessions.
The real challenge in telehealth today lies in creating sustainable, profitable business models that can meet the needs of governments, service operators, practices and, of course, patients. While frame rates, compression, 128-bit encryption and other technology terms have dominated telehealth discussions over the last few years, we need to focus on scalability and sustainability to ensure
the industry’s existing investments have not been in vain. And let’s not forget the important `P` word: profitability. Regardless of your view on bulk-billing versus private billing, or for-profit versus not-for-profit, no one can deliver loss-making services sustainably. We need to understand the hidden costs of telehealth that are only now really starting to emerge as programs start to operate at scale.
Supply and demand Delivering a successful telehealth program is fundamentally about matching patient demand with provider supply, whilst maintaining cost effectiveness and efficiency. It has to be a positive experience for patients and providers. If it doesn’t meet these basic needs for either party, it will not be sustainable or scalable. The first question you should be asking yourself is not “what’s the best video conferencing solution for my practice?” but “what’s the business model to help me meet my needs and that of my patients?” To do this properly you need to understand the business of telehealth. Crucially, there are a number of hidden costs in delivering telehealth in small- and large-scale settings.
1. Patient no shows, late cancellations and failed consults Unlike a traditional practice, it is difficult to overbook an online session. No shows, cancellations and consults disrupted by technical issues are not easily filled at short notice, which can result in lost consultation time and/or significantly lower hourly billing. Developing a model to address these issues whilst ensuring lost hours are utilised productively, particularly as you increase in scale, is critical. 2. Billing Creating a solution to bill patients is administratively challenging, as your patient isn’t physically in your rooms during a consultation and may never actually visit your practice. For most providers, introducing a patient co-pay system for telehealth will become a necessity, but this will inevitably further complicate the process and increase the amount of administrative support required. 3. Scheduling and end-point challenges Scheduling patient consult length to match their clinical requirements will affect your ability to maximise consulting time. Having patients conduct video consultations from their GP’s rooms can increase the scope of practice and allow for more reliable end-points. However, this often creates scheduling challenges and increases the percentage of booked consultations that do not eventuate. As patient consultations move into the home, it is likely that technical and clinical challenges will increase. 4. Doctors’ charges A doctor’s time online costs the same as it does face to face. Inefficiency through scheduling gaps can quickly make online consultations more expensive than providing face to face care. 5. Funding streams Existing MBS telehealth funding has limitations, both in terms of item numbers that can be used for online consultations
“Regardless of your view on bulk-billing versus private billing, or for-profit versus not-for-profit, no one can deliver loss‑making services sustainably.” Sam Holt
and the fact that it doesn’t support asynchronous/store and forward and other telehealth modalities that can deliver good clinical outcomes with more efficiency in some circumstances.
the reality is that most providers can utilise free software-based solutions to meet their needs.
6. Practice management support Ensuring that clinicians spend their time consulting and not chasing referrals, reports, scans or conducting technical support requires practice management support. Most doctors prefer to consult rather than perform administrative tasks, so the costs of practice management support should not be overlooked when creating your telehealth model. This becomes increasingly apparent with scale.
Once you start delivering telehealth at scale, it becomes necessary to invest in billing platforms, online booking tools, scheduling tools and other elements to make your online practice secure, scalable and a great customer experience. By factoring the true costs of telehealth you will be able to create a telehealth model that will meet the needs of your practice and your patients. If you can solve the business challenges of delivering telehealth, choosing the right video platform, devices and peripherals (such as web cameras) will become relatively simple in comparison.
7. Opportunity costs For some providers, telehealth can pose a significant opportunity cost. Whether you count costs in terms of possible lost consulting time (patient no shows), potentially lower billable hours or the space required to host a patient’s specialist consultation, there is inevitably an opportunity cost to consider. 8. IT infrastructure Hardware vendors did a great job convincing governments and early adopters to part with significant funds for shiny screens and hardware. Many of these systems are sitting idle across the country as funds were directed at infrastructure rather than ensuring an appropriate supply of specialists to conduct consultations. It’s easy to spend big on IT infrastructure, but
The true costs of telehealth
The future of telehealth is bright, exciting and delivers new opportunities outside of video conferencing. As current government incentives taper off or are refocused, new models of care will start to develop, particularly asynchronous/store and forward services, that are often cheaper, faster and more efficient. Factors such as whether WebRTC is better than Vidyo, Skype, VSee or any other video platform is largely irrelevant in the debate about the future of telehealth in Australia. What will decide telehealth’s fate and role in years to come will be well-thought out funding models and our industry’s ability to devise sustainable and scalable business models.
Majority of public hospitals to upload discharge summaries to PCEHR this year The National E-Health Transition Authority (NEHTA) has compiled a list of public hospitals in Australia that are capable of submitting discharge summaries to the PCEHR.
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Almost 200 hospitals are listed, all but one of which are from Queensland, NSW and South Australia. Queensland is using its The Viewer application – a clinical portal that Queensland Health has been building for several years – to enable acute care clinicians to view patient records. It is using an enterprise discharge summary application to send discharge summaries to the PCEHR, and is working on sending discharge summaries in CDA format point to point to GPs. Queensland has had a healthy point-to-point network for non-CDA discharge summaries for some years.
The vast bulk of Queensland hospitals now have the capability, including tertiary hospitals such as Princess Alexandra, Royal Brisbane Women’s and Children’s and Gold Coast, as well as large regional hospitals such as Toowoomba, Cairns and Townsville and most of the smaller regional hospitals. Queensland has for some years had a locally organised capability to send discharge summaries directly to the referring GP through secure messaging. In NSW, those hospitals that pioneered PCEHR discharge summaries in western Sydney and the Nepean-Blue Mountains area are listed, along with the children’s hospitals at Westmead and Randwick, other large hospitals on the Randwick campus including Prince of Wales and the Royal Hospital for Women, St George Hospital and several in the Illawarra Shoalhaven region,
including Wollongong Hospital. Sydney’s St Vincent’s Public Hospital, which has had the ability since 2012 and was the first to achieve the result, seems to have been left off the list, as has Calvary Hospital in the ACT. Canberra Hospital is listed, as are all metro hospitals in South Australia, with Gawler Hospital acting as a pilot site for SA country hospitals. South Australian hospitals have pioneered the move on a statewide basis, beginning to send discharge summaries to the PCEHR from metropolitan hospitals in August 2013. NEHTA CEO Peter Fleming said South Australia had worked with a private company to develop a Healthcare Information and PCEHR Services (HIPS) application, which is being used as middleware to link acute care information
systems that are not yet integrated with the PCEHR to enable clinicians to interact with the system. Mr Fleming said NEHTA now owned the intellectual property for HIPS and Western Australia and Tasmania were planning to using it. Victoria has also expressed interest, he said. Mr Fleming said there had been very little work done with private hospitals. “There are a few we are working with but, at this stage, because of our relationship with the jurisdictions and as a first step we have been concentrating on the public hospitals,” he said. “The intention is that we will also make [HIPS] available to the private sector.” The Northern Territory has indicated it is waiting until it completes its M2N project – in which the MeHR is transitioned to the national PCEHR – but it is likely to use HIPS.
Victoria is yet to implement the capability as it is currently undergoing statewide IT reviews. Pulse+IT understands that Victorian local health districts will decide their own path, and that Barwon Health in Geelong and Melbourne’s Eastern Health are close to implementing the capability.
“NEHTA was aiming to have 50 per cent of public hospitals in the country with access to the PCEHR by this month.” It is unclear as yet when Western Australia is planning to implement the functionality. NEHTA declined to provide further clarification. Mr Fleming said NEHTA was aiming to have 50 per cent of public hospitals in the country with access to the PCEHR by this month, and have enough
public hospitals enrolled to cover 75 per cent of the Australian population by June or July. In the meantime, the Department of Health has suspended a teleconference planned with industry representatives scheduled for February 6, during which progress on uploading pathology results and advance care directives to the PCEHR was to be discussed. The capability to upload pathology results and advance care directives was due to be available with the PCEHR release five in April, but it is understood this release has been suspended until the new government makes its plans for the whole system more clear. A spokesperson for the Department of Health said that as of late January, there were 1,348,903 consumers registered for the PCEHR, with 13,585 discharge summaries uploaded and 13,016 shared health summaries.
No date set for government response to PCEHR review Health Minister Peter Dutton is currently considering the report prepared by the Royle PCEHR review panel received just prior to Christmas, but has not committed to a date for the government’s response. Mr Dutton issued a brief statement on December 20 announcing he had received the report from the three-man panel, which was convened in early November and asked to review the implementation and uptake of the PCEHR. The review’s terms of reference included assessing the level of consultation with end users during the development phase, the level of use of the PCEHR by healthcare professions in clinical settings, barriers to increasing usage in clinical settings, and key clinician and patient usability issues. The head of the review, UnitingCare Queensland’s executive director Richard Royle, told the HITWA conference in Perth in November that there was “no intention to kill off” the PCEHR. A spokesman for Mr Dutton said it was too early in the process to answer questions put to him by Pulse+IT about the PCEHR, as well as the future of the National E-Health Transition Authority (NEHTA), funding for which is due to end on June 30. It is understood that the federal government has not yet committed to its 50 per cent share of ongoing support for the COAG-funded organisation, and nor have some states. Mr Dutton’s spokesman said the minister was currently considering the report and its recommendations. “It provides a comprehensive plan for the future of e health records in Australia,” he said. “The Minister will respond in more detail in due course.”
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Maternity information system delivered in the cloud St Vincent’s Private Hospital in Melbourne has installed an information system for electronic maternity assessments that is believed to be the first such system delivered in the cloud. The maternity system comprises several of Emerging Systems’ EHS clinical information system (CIS) modules, of which some are maternity-specific including assessments, labour and birth records, and maternity reporting. A full maternity CIS will progressively be deployed throughout the hospital over the next 12 months, providing an electronic health record for maternity services. Emerging Systems’ clinical implementations group manager Bryan Macdonald said the first stage of the roll-out allows midwives to use electronic assessments to capture antenatal, postnatal and newborn assessments. The next stage will include the ability to record observations and diet requirements as part of a move to a full electronic health record. And as EHS is fully eHealthcompliant, it will also see work done on allowing the hospital to register newborns for an Individual Healthcare Identifier (IHI) through Medicare, Mr Macdonald said. The maternity information system is provided as a software-as-a-service through a private cloud hosted in Sydney. Midwives in Melbourne can enter the data through workstations on wheels at the woman’s bedside. In addition to St Vincent’s Private in Melbourne, EHS is being rolled out throughout St Vincent’s Health Australia’s (SVHA) 14 hospitals in Queensland, NSW and Victoria. It has also been selected by St John of God Health Care, commencing with the new St John of God Midland hospitals in Perth.
NSW creates eHealth strategy for rural and remote areas NSW Health is developing an eHealth strategy for rural and remote NSW that will lay out plans for the continued rollout of the statewide electronic medical record. The long-awaited rollout of electronic medications management systems (eMM) throughout the state’s hospitals is also going ahead, with NSW Health’s eHealth agency, HealthShare NSW, announcing recently that it would shortly issue a request for tender for eMM software for all NSW local health districts (LHDs). This implementation has been funded by an allocation of $170 million over 10 years announced in the 2011 state budget. A
panel of eMM suppliers will be formed as part of the tender process, from which LHDs can then choose a preferred eMM system for their area. The draft plan for eHealth for rural and remote NSW will be sent to all rural CEOs and CIOs for their endorsement. It will set out an implementation strategy for a range of clinical health IT initiatives over the next five years. HealthShare NSW business architect and acute care physician Will Reedy told an Australian Internet Industry Association (AIIA) function in Sydney recently that the agency planned to get a memorandum of understanding signed between HealthShare and
the rural and remote chief executives to commit to delivering eHealth at a more accelerated rate. “There is a real desire from the rural CEOs to get as much eHealth capability as possible installed and being adopted by their end users by the end of [the] year,” Dr Reedy said. The strategy has been developed following consultation with the six rural and remote LHDs, none of which had their own vision or strategy for eHealth, or any dedicated funding for driving eHealth. However, there was notable support for eHealth among both clinicians and patients, Dr Reedy said. “There is strong clinical support for
eHealth but that is also tempered by the fact that they are frustrated by lack of progress. “They know the technology exists but they want to know why can’t they use it today. There is some real frustration with some of the clinicians.” He said there was also a strong consumer push in rural and remote NSW for patient access to their medical records. LHDs were also keen to use the PCEHR to enable shared access to health information from a range of private and nongovernment providers in rural areas. “As part of the rural strategy we need to think about what we would do differently and what we would require the rural LHDs to do differently to get this eHealth capability deployed over the next 12 to 18 months,” he said. Many patients from rural NSW also access healthcare in other states, so NSW will work with the other states in terms of patient flows and sharing information, and the mechanism for doing that was the PCEHR, he said. “We have a number of clinical programs and a number of corporate programs and a wide range of infrastructure programs and we need to change how we deliver some of that, so we are going to
appoint a rural eHealth director to coordinate all of our programs into the rural LHDs. We will deliver capabilities as releases across those different programs rather than doing individual projects.”
“There is strong clinical support for eHealth but that is also tempered by the fact that they are frustrated by lack of progress.” One of the main barriers to wider uptake of eHealth and health technologies is the poor infrastructure, particularly broadband, experienced in regional NSW, he said. “Network connections and broadband speeds are often less than what we have at home at the moment so it is a real challenge for them. “We also need to address support, as there is no point in putting all of this eHealth capability in over the next 12 months and then walking away and not supporting it. “But probably the most important thing for rural CEOs is just having a single patient record. They have made that decision to have one EMR for all acute and community clinicians and one mechanism for accessing and sharing that
information with other healthcare providers.” Rural and remote LHDs will get the Cerner EMR – Hunter New England is the exception in NSW, having already installed an Orion EMR – while an Orion clinical portal allows access to the PCEHR and a range of regional clinical repositories built as part of the HealtheNet project. Dr Reedy said there was also a Ministry of Health mandate to report on the activity that hospitals are completing for both admitted patients and non-admitted patients, and a real consumer push for eHealth. “There is significant priority assigned by the CEOs to giving patients access to their record and selfmanaging their care. The PCEHR enables us to do that so that is the strategy we’re going to use.” Former NSW Health CIO, Greg Wells, said the PCEHR was“fundamental” to the eHealth strategy. “[The PCEHR] is not perfect, we all know that, but no one is coming along with another billion dollars for eHealth in our time,” Mr Wells said. “If we don’t make this work there is not another chance and we will go backwards 10 years. Yes, there is usability and things to fix up, but it is critical.”
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Second South Australian hospital goes live with EPAS
Dr Info trials patient info look-up with after-hours GP service
Port Augusta Hospital has gone live with SA Health’s Enterprise Patient Administration System (EPAS) integrated electronic health record, the second hospital in the planned roll-out of the Allscripts-designed system.
New Zealand health IT firm Dr Info is trialling its Care Insight urgent care system with a group of GPs running an after-hours service in NSW.
EPAS was implemented in Noarlunga Hospital in August last year, along with four GP Plus centres, SA Ambulance headquarters and a palliative care unit at Adelaide’s Repatriation General.
Care Insight is a joint venture between Dr Info and secure messaging provider HealthLink that allows emergency department clinicians and after-hours medical services to quickly look up a patient’s medical summary from any GP or community pharmacy.
Metropolitan hospitals, including the tertiary facilities at Royal Adelaide, Flinders Medical Centre and Lyell McEwin, are planned to come online over the next year or so, along with Mt Gambier Hospital. SA Health said 400 staff at Port Augusta received training over six weeks on the use of the new system. A 24/7 clinical solution support centre has also been set up to provide them with assistance to ensure the transition to EPAS goes smoothly. SA Health chief medical officer Paddy Phillips said clinicians at Port Augusta would now be able to access medical records electronically and order tests, medications and review results from computers at the patient’s bedside and other points of care around the hospital. SA Health has rolled out 3500 bedside computers throughout the state. “Details of a patient’s treatment plan, their test results and information about medications they may be taking will all be available on EPAS,” Professor Phillips said. SA has also opened two new operating theatres at Port Lincoln Hospital on the Eyre Peninsula equipped with telemedicine and teleconferencing facilities to allow local surgeons to collaborate with colleagues in Adelaide.
Used widely in emergency departments in NZ’s North Island, the system allows ED and after-hours doctors to request patient information – with the patient’s consent – that is held within general practice or pharmacy software. It is facilitated by an agent that sits on participating GP and pharmacy servers. ED doctors are able to send out a request for a look-up, which alerts the agent, which then pulls out relevant information and presents it as a medical summary card to the ED doctor through an easy-toread interface. Only essential information is provided to the requesting doctor, such as diagnoses, medications and alerts. Dr Info provides the database agent and the interface, while the system runs on the GP or pharmacy
HealthLink server, so the medical record itself does not leave the practice. All requests and access to patient records are tracked, providing not only an audit for security purposes but also informing the GP that a patient has attended hospital. Dr Info general manager Lynn Taylor said a group of GPs running an afterhours service in NSW are now running a pilot of the system.
“For emergency departments, all they want to see are diseases and classifications that have been coded, medications, and medical alerts for the patient.” Dr Taylor said that while individual organisations can use the system, it is better aimed at regional and national networks serviced by Medicare Locals and local health districts. In New Zealand, Care Insight is used by district health boards and primary healthcare organisation, although the ultimate aim is to have it available nationwide.
“It started off as way that people within a region could share information between themselves, but we’ve never meant it to be a closed network,” she said. “Our whole philosophy is that if you are in the Care Insight network in New Zealand, it is a national network. If you’ve agreed to having Care Insight installed and your patient turns up in an emergency department or after-hours service outside of their normal home town, they can still reach out for a record of your patient.” Dr Taylor said that rather than providing a full medical history, as is the ultimate aim of the PCEHR, the information provided through the medical summary card is only that which is pertinent to emergency doctors. And rather than building a very large centralised database, the idea is to connect distributed databases and allow information sharing on demand. “There are a lot of information silos out there, some in general practices, some in pharmacies and some in community health organisations,” she said. “One solution is to build a really big centralised system … where everyone shares the one electronic health record and that is
a bit of a nirvana, but the other option is the here and now. For emergency departments, all they want to see are diseases and classifications that have
been coded, medications, and medical alerts for the patient.” In addition to EDs, Dr Info is now being used by
registrars and specialists to look up summary records from within hospital wards, and by community and hospital pharmacists for medications reconciliation.
HotDoc the new kid on the block Melbourne-based HotDoc is the latest company to enter the growing online medical appointment booking market, offering a customised web booking application with a free mobile app and with plans to launch extra add-on features such as a practice management dashboard. Established by Melbourne doctor Ben Hurst last year, HotDoc has its sights set on improving patient flow and other efficiencies for general practices, and plans to differentiate itself by helping clinics make the best use of some of the existing analytical
functions within practice management software. HotDoc is integrated with Best Practice, PracSoft and Zedmed, and recently launched an iPhone app for patients. Unlike patient-centric online appointment booking services, Dr Hurst said HotDoc was aligning itself with the practice-centric market along with the likes of DocAppointments, Appointuit and Clinic Connect. Dr Hurst said HotDoc plans to differentiate itself by offering full customisation to practices based on
doctor preference, including retaining a manual system to allow practice staff to become used to online. “An appointment isn’t just clicking on a time and sending a confirmation email; it’s about trying to get the right appointment with the right doctor every time,” he said. “We do have that threepoint process of selecting a reason for the appointment, selecting a doctor and then selecting a time and that essentially funnels all of our patients into the right doctor according to their preference. “The other thing we do is we have a customised process of patient transfer into the schedule. We do have an automated transfer but we also do a manual transfer. Even though that doesn’t necessarily improve the efficiency, what it does do is allow practices to have an additional layer of control.” He said he aimed to offer both a good web application and an app. “We’ve gone web first and mobile second.”
Western Australia to extend virtual ED telehealth service Western Australia is expanding its Emergency Telehealth Service (ETS) to the state’s Goldfields as part of plans to have most WA Country Health Service (WACHS) hospitals using the system by 2015. ETS began as a pilot program in eight Wheatbelt hospitals in 2012, and has since extended to 28 predominantly small hospital EDs in the Wheatbelt, Midwest and Kimberley. WA Health Minister Kim Hames said the Goldfields region will be the next region to receive ETS, with staff orientation sessions currently under way. Almost all of the consultations are with nurses staffing small rural hospitals without medical cover, and are conducted by about 20 emergency medicine specialists using high-definition video conferencing based at the WACHS in Perth or at home. Dr Hames said that since the service began, more than 4500 patients had been seen, with 71 per cent diagnosed and treated at the presenting hospital, reducing the need for them be transferred. “In many cases, improved access to specialists within their own communities reduces the need for patients to travel to the metropolitan area or other major regions, which also lessens the burden placed on these patients when they are away from their home towns,” he said. “The ETS is having a positive [effect] on front-line clinicians in remote locations, who are often working in isolation, managing complex emergency presentations.” The expansion into new regions is being funded as part of the state’s Royalties for Regions program, with $36.5 million allocated to telehealth technology.
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API for Medicare and DVA claiming set for launch
Dr Foster now on offer as Telstra moves into acute care
Melbourne start-up company claiming. com.au is about to launch a new technology platform that promises to make integrating Medicare billing with practice management software a much easier process.
Telstra’s new healthcare division has secured the exclusive rights to provide the Dr Foster risk-adjusted quality measurement tool for hospitals in Australia.
Claiming.com.au has developed an API it will market to general practice and allied health software vendors to allow them to easily integrate online claiming with Medicare and the DVA.
Telstra’s head of health, Shane Solomon, said 17 hospitals in Australia were currently using the tool and the Victorian government had recently contracted Dr Foster’s Quality Investigator platform for its major hospitals.
For end users, the technology aims to speed up the response times of Medicare claims by using an efficient queuing system and data pre-validation. It will also enable users to see in real time that a claim has been rejected and why. Claiming.com.au director Sam Stewart said the system would improve claiming in two ways. “One is an efficient queuing system so that developers will send [a claim] through to us and we will hold it and ping it off for submission,” he said. “We will meter it and keep sending it through to Medicare at a rate that they can handle, and only send it back out when it is ready.” The other is pre-validation of the claim at the time of input by the user. The platform will enable immediate membership number validation but will also bring up a plain English error message if an invalid claim is entered. “This compares to the traditional path which was the user would put it in perfectly fine and submit it and get an error message, or if sending it via the paper channel, two months later they’d get a notification coming back saying you can’t get paid for this,” Mr Stewart said. “For the medical software vendors, the real focus is, once integrated with our API, their cash flow should significantly improve.”
The five-year agreement also includes the option to extend the relationship into Asia. Telstra will take on the management of Dr Foster’s existing customer base in the region. Dr Foster was established in 1999 by two UK
journalists as a way to publish information on the quality of NHS hospitals. Named after the ‘Dr Foster goes to Gloucester’ nursery rhyme, it has published an annual Good Hospital Guide since 2001, and in 2006, the NHS became a joint venture partner in Dr Foster Intelligence. The company now provides analytic services to around 85 per cent of NHS hospitals as well as to some in Europe and the US. It uses risk-adjusted death rate methodologies developed and maintained by Professor Brian Jarman of Imperial College in London. Mr Solomon said that in the last three or four years, the tool had developed the
maturity to enable quality improvements rather than just accountability. “It’s an application that takes the normal data that is collected on people in hospital, so there’s no extra data needed, and by using Imperial College [methodology] they do a risk adjustment,” he said. “So if you are older and have a history of diabetes or renal disease, and you are coming in for a cardiac operation, your chances of death are higher. They risk-adjust every individual based on that combination of factors. “That’s the main issue that clinicians have with measuring quality in hospitals. They say, ‘Of
course more of my patients die because more of them are sicker or they’re older.’
number, you have actual deaths of Y. Then you can investigate why.”
“Imperial College has got that covered through the risk adjustments, and Dr Foster takes the data set and adjusts it for individual conditions like a cardiac event, and it tells you that while you should have expected deaths of X
Mr Solomon said the system had the capability to to find out where and why problems were occurring or not measuring up to certain benchmarks. “It’s not just a macro reporting system,” he said. “It’s a tool for hospitals to see
which individual procedure or diagnosis they are doing well or badly, and then start analysing exactly how. If you keep hitting the ceiling then some alarm bells will go off. “In the UK, they have decided to use it as a device for improvement rather than a device for condemning people.”
Best Practice and Zedmed integrate with Tyro Easyclaim and NPDR Clinical and practice management software solutions Best Practice and Zedmed are now both integrated withTyro’s EFTPOS Medicare Easyclaim solution, which enables Medicare rebates to be paid into the patient’s bank account almost immediately. Both companies are also soon to release new versions of their clinical software that will allow users to register patients for the PCEHR directly through the software, and to send medications information to the National Prescription and Dispense Repository (NPDR). Tyro’s integrated solution was previously only available with HCN’s practice management packages PracSoft or Blue Chip, as well as medical billing software provider Medilink.
It recently became available with Practice 2000, and is now integrated within Best Practice and Zedmed’s management modules.
“The patients are reimbursed their Medicare rebate before they leave the practice.” Best Practice chief commercial officer Craig Hodges said users simply had to contact Tyro to arrange for a terminal to be delivered, but subscribers to its clinical software have to also be using its clinic management module. Zedmed’s marketing and sales manager Rosemary Lloyd said the Tyro integration would allow for simplified billing and claiming, and patients can receive their Medicare
rebate in as little as 11 seconds. “Integration means that payment amounts and Medicare details are automatically sent from Zedmed to the Tyro terminal, removing the need to manually key this information into the EFTPOS device before taking the patient’s payment,” Ms Lloyd said. “Patients don’t need to register their bank details with Medicare and they’ll have their money back into their account before they pay to have any prescriptions filled.” Both Best Practice and Zedmed are also due to release new PCEHR functionality, including an inbuilt assisted registration tool (ART) that will allow doctors to register patients for the PCEHR while they are in the surgery.
Best Practice to release ART and NPDR features Clinical and practice management software vendor Best Practice has appointed a dedicated product manager as it prepares for its next version, which will include an in-built assisted registration function for the PCEHR and a view of the National Prescription and Dispense Repository (NPDR). Best Practice has promoted Mitchell Grotherr to the position of product manager, where he will work with CEO and founder Frank Pyefinch to coordinate the design, development, testing and release of the Best Practice range. Mr Grotherr will be responsible for liaising with third-party software vendors to explore integration opportunities and for the scoping of software enhancements and new desirable user functionality. Best Practice is currently in the final stages of testing for its next version, which will include in-built ART and NPDR functionality, and integration with Tyro terminals. The ART will allow doctors to register their patients for the PCEHR from within the software, while the NPDR view will enable them to review each PCEHR registered patient’s prescription and dispense history. While the NPDR is still being rolled out to pharmacies, doctors can upload scripts to the repository at the same time that they send them electronically to the eRx Script Exchange. The current version of Best Practice integrates with Argus as its default secure messaging provider, and the company is also working on integration with the MEDrefer online referral service. MEDrefer includes a dashboard so GPs can see a list of the status of all of their referrals sent using the system, including referrals that have been issued, replied to, rejected and completed.
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Triple zero app with GPS locates in emergency National emergency services organisations have launched an app that allows callers ringing Triple Zero on their mobiles to be located by GPS tracking. The free Emergency+ app has been developed by the national Triple Zero Awareness Work Group (TZAWG) following concern about the release of smartphone apps that claimed to send location details to emergency responders, but which couldn’t be guaranteed to perform. TZAWG operates under the Australian Communications and Media Authority (ACMA). Two-thirds of all incoming calls to Triple Zero are now made from mobile phones. If callers ring 000, the SES or the Police 131 444 line on their phone and they are unsure of their exact location, they are asked if they have the app on their smartphone and if they can then verbally read out their exact latitude and longitude GPS coordinates. Rather than ringing 000 directly, the caller can open the Emergency+ app on their phone and tap Triple Zero to make their call. The receiver then asks them to press the Emergency+ icon, which will take them to their map coordinates and they can read out their lat/long information. It is designed to help people pick the right emergency number to call for help in emergency and non-emergency situations. Information on other national numbers such as Crime Stoppers will also be available. It will also assist country fire services to improve the response time of crews to incidents including bushfires and road accident rescues. The app can be downloaded from the iTunes and Google Play stores.
WentWest links LinkedEHR care planning to HealthPathways portal Western Sydney Medicare Local (WentWest) has begun integrating its HealthPathways web-based clinical decision support portal into its recently launched LinkedEHR shared care planning system, which has been designed to facilitate better team care arrangements between GPs, specialists and allied health practitioners. Piloted in July last year, LinkedEHR allows local clinicians to create GP management plans and team care arrangements and provide access to other clinicians working with the patient. It is suitable for any chronic illness as it is based on the ICPC 2 coding system, and is currently being rolled out as a pilot initially to GPs and allied health professionals such as podiatrists and dietitians who are sharing the care of patients with diabetes. Local hospitals have also shown interest in using the system with their diabetic patients, and patients have a view-only access to their shared care plan. LinkedEHR has been designed by Ocean Informatics based on its open source openEHR technology and using the Multiprac CP application as its basis. It is being offered to GPs and allied health practitioners in the Western
Sydney area free of charge. Authorised users are also able to view a patient’s PCEHR from within the system. It is now being linked to WentWest’s HealthPathways portal, which allows clinicians to access standardised care pathways that are tailored to local resources and services.
“Rather than just going out with an offering that is looking for a use, we are beginning with diabetes so there is a concrete, tangible benefit to the GP.” WentWest’s Paul Campbell said one of the ideas behind rolling out LinkedEHR was the realisation that GP management plans and team care arrangements were not being reviewed that often. While they can be created from within the GP’s desktop software, most actual information sharing with allied health practitioners and medical specialists was still being done on paper. “In Western Sydney in the first quarter of 2013, there were about 33,000
of a combination of GP management plans and team care arrangements billed through Medicare, but in that period there were only 21,000 reviews of these plans,” Mr Campbell said. “One would have expected two to three times the number of reviews as basic plans.” WentWest has registered with the national eHealth system as a contracted service provider (CSP) so it is able to interact with the PCEHR and the Healthcare Identifiers Service on behalf of clinicians. To allow GPs to easily use the system, WentWest has worked with Pen Computer Systems to install a button on its PrimaryCare Sidebar tool to allow data to be extracted from the GP’s clinical software and sent to the LinkedEHR server, which is hosted by WentWest, not on the GP or allied health practitioner desktop. This server has all the privacy and security compliance features of the PCEHR. “We manage it directly,” Mr Campbell said. “[The GPMP] is held on that server so that anyone who is registered on the system can have access to it and update it. The GP can also see any of the other participants in the team who have updated that record.”
WentWest is also working with the Western Sydney Local Health District to provide access to hospital clinicians. The roll-out to GPs is being based around a joint
diabetes strategy with the LHD, WentWest’s Ian Corliss said. “Rather than just going out with an offering that is looking for a use, we are beginning with diabetes
so there is a concrete, tangible benefit to the GP and broader care team in terms of patient groups, particularly as diabetes is identified as a health priority in the region,” Mr Corliss said.
Guidelines required on use of medical apps and mobile devices Monash University researchers have called for the development of guidelines on the use of mobile devices and medical apps in clinical practice to ensure safety and quality. While there are many obvious benefits to mHealth applications, including access to information at the point of care, there are also some risks that need to be confronted, Monash University researchers Jennifer Lindley and Juanita Fernando argue. In a paper published in the European Journal of ePractice, Ms Lindley and Dr Fernando write that
with WHO figures showing more than a third of doctors and almost three-quarters of nurses using medical apps on smartphones daily for work purposes, “it is imperative to scrutinise the use of mobile devices and medical apps in healthcare and develop a more considered and comprehensive approach.” Mobile devices are also very attractive to healthcare practitioners as they are often easy and pleasurable to use, and voice-activated applications and services, convenience and reduced computer start-up time are also cited as attractive to clinical end-users.
However, there are also disadvantages and significant risks, including their potential to distract clinicians through email sign-ups, pop-ups, advertising banners, notifications and alerts. There are also welldocumented privacy and security concerns over the loss or theft of devices, the potential for voice and video calls to be intercepted, and social media conversations being permanently stored on devices. Another potential drawback is the lack of knowledge on the part of some app developers about the particular standards used in healthcare, and the potential to embed data mining capabilities. “Guidelines providing certainty around the use of mobile devices and medical apps in clinical practice are necessary to inform best practices and ensure safety and quality in technologylinked patient care,” the researchers say.
Consumer perspective getting lost in PCEHR debate Melbourne-based digital design consultancy Navy Design is planning to undertake a month-long research project to gauge consumer attitudes towards the design and functionality of the PCEHR in the hopes that it can inform the ministerial review into the system. Navy Design’s general manager Michael Trounce said the consumer perspective had been lost in the debates over the clinical utility of the PCEHR, in particular the fundamental usability of the system, which he believes is not particularly good. “We believe you have to spend lots of time with the people who are going to be using the system, but that doesn’t seem to have happened with the design of the PCEHR,” Mr Trounce said. “It needs a lot more development, in our opinion.” Mr Trounce said the plan was to recruit a group of consumers and test the system with them in their homes, asking them to create a record and then assess its relative difficulties. “We then hope to release a report that can inform the debate,” he said. “We want to be constructive and to highlight what is wrong with the system and suggest some ways it can be improved.” Navy Design is currently assisting an aged care software provider with a similar project, working with the vendor to improve the usability of the software for clinicians. While the PCEHR has been designed as a clinical record, there is no reason why it could not be more attractive and easy to use, he said. “When it comes to eHealth, the quality of the user experience can have a direct impact on health outcomes. That’s when good design is really critical.”
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PCEHR to be modified to allow health record overview The National E-Health Transition Authority (NEHTA) has announced there are plans to modify the PCEHR infrastructure to allow a new overview to be presented in clinical software, and has also launched a training environment to let organisations give the PCEHR a test run with simulated data and patients. The training environment currently supports GP and specialist software from Best Practice, Communicare, Genie, Medical Director, MedTech, practiX and Zedmed. NEHTA said other software products would be added over time. Bookings for the resource are required, and the organisation will then provide instructions on how to connect to the environment and run the simulations. NEHTA has refused Pulse+IT’s request to attend a simulation, and has declined to respond to any enquiries since the commencement of the PCEHR review. NEHTA also announced that following feedback from primary care clinicians, the PCEHR infrastructure will be modified to support a health record overview (HRO) as a common method of presenting the lists of documents uploaded to individual patients’ PCEHRs. “Subsequent to that, primary care software vendors will build the HRO into their software products,” NEHTA said. “This work is underway, with the first software able to display the HRO expected to be available in mid-2014.” NEHTA said feedback had been provided to software vendors from clinicians about certain aspects of the PCEHR, including populating and uploading a shared health summary and the way in which some information is handled in the document, and planned to do the same next year for event summaries.
The San goes live with AMT mapping for drug allergies in EMR The Sydney Adventist Hospital (SAH) has gone live with an updated version of its SNOMED-enabled allergies list that includes mapped brand and generic names for drugs through the Australian Medicines Terminology (AMT). SAH, also affectionately known as The San, first instituted an allergies picklist based on SNOMED-CT AU within its electronic medical record SanCare in 2011. Previously, about 90 per cent of allergies information was entered as free text, as nurses and clerical staff had difficulty finding the right description. Following the introduction of SNOMED-CT AU, the amount of coded allergy data improved from about
10 per cent to over 60 per cent. Both clinicians using the EMR as well as patients who were using the hospital’s pre-admission module eAdmissions were managing to code their allergies through the list, which meant reports were then able to be integrated into the hospital’s dietetics system CBORD and its MetaVision ICU system. The hospital then discovered that the remaining 40 per cent of allergies that were still being entered as free text were predominantly drug-related, so it began a two-year process, working with NEHTA, to institute a version of the AMT. According to SAH’s project manager for health informatics, John Sanburg,
it is now hoped that levels of allergies entered as code will rise to over 90 per cent. Mr Sanburg said the hospital had created its own drug-allergy list but it was not “heavy duty” enough, so NEHTA guided it in the direction of the AMT. “If a patient comes in and says they are allergic to Panadeine, which is paracetamol plus codeine, the patient wouldn’t know if it was the paracetamol or the codeine that they were allergic to,” Mr Sanburg said. “If they say they are allergic to codeine that’s all very well, but there are about 70 different trade names of codeine on the market. We don’t want to list 70 so we have to select the most common. What we have
done is mapped the trade and the generic together so we define the same thing.” The hospital still encourages the clinicians to enter some form of free text in the EMR via a comments section if they think it’s necessary. It also plans to do a problems/ co-morbidities list along similar lines. Through eAdmissions, which SAH developed in
association with Sydney firm EpiSoft, about 30 per cent of pre-admissions forms are now being filled out by the patients themselves. eAdmissions has the same ability to code their allergies through a patient-friendly list that is then linked to the main allergies list. “Likewise with food, if they have an anaphylactic reaction to nuts or something, they would
choose that and that will come across to our system and will also go across to CBORD, which is our diet module, and because it’s all coded you can interface it nicely,” Mr Sandburg said. For food and contrast allergies, it is using severity levels. Data about contrast allergies is sent to the Agfa radiology information system, and the clinician or the patient can note the degree of severity.
AutumnCare to let GPs connect for medications profile of elderly patients Aged care software vendor AutumnCare is building functionality to enable general practitioners to view a full medications profile of their patients in residential aged care facilities, generated by AutumnCare’s Medicate module. GPs are currently able to remotely log in to the system to request medication changes from the resident’s nominated pharmacist. The changes are automatically inserted into Medicate and an alert emailed to the pharmacy. Medicate allows aged care facilities to easily create a medications profile containing full demographics, the resident’s regular packed medications, non-packed medications, as-needed
medications (PRNs) and stat medications. It is fully integrated with pharmacy packing systems Webstercare and Fred Pak, which AutumnCare managing director Stuart Hope said covered about 80 or 90 per cent of the pharmacy market. Mr Hope said while the company would do a pilot of the GP log-in function before releasing it widely, version 4.5 of AutumnCare is due this year and will have a number of functions that he has been keen to add to the product for some time , including a dynamic Glasgow coma scale and the ability to chart all vital signs in a dynamic way. “It’s very sexy,” he said. AutumnCare is also building functionality within
Medicate to allow nurses to see when a medications patch has been applied and reapplied. Dermal patches, which can prove difficult to track within traditional systems as they often applied on different parts of the body, can come loose and need to be reapplied, and some are meant to last 24 hours but others for several days. “We take data from AutumnCare and from the pharmacy so if you administer a PRN it automatically creates a progress note and marks it at handover,” Mr Hope said. “It is also integrated on the web so GPs can go to a secure website or if they have a smart phone they can log on and put in medication change requests.”
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Digital health summit at Connect Expo A one-day conference on digital healthcare is one of six summits organised as part of the inaugural Connect Expo, being held in Melbourne in March. Sponsored by the Victorian government and supported by the Australian Information Industry Association and the Australian Computer Society, the expo is an ICT tradeshow with a focus on emerging digital technologies. Along with summits on digital government, digital entertainment, enterprise mobility, M2M and the Internet of Things, and a Next Big Thing summit, the healthcare summit will look at how new technologies are changing the way healthcare is delivered and patient care is monitored. It will cover next-generation medical devices, remote monitoring, mHealth apps and products, cloud-based medical services and consumer-focused wellness and fitness devices. The expo will feature a large-scale, immersive show floor with dedicated technology pavilions for each conference along with connected play zones to showcase the latest devices and gadgets. Speakers at the Digital Health Summit include the CIO of the federal Department of Health, Paul Madden; University of Sydney professor of public health and community medicine, Stephen Leeder; and UnitingCare Health Queensland executive director and head of the PCEHR review panel, Richard Royle. The summit will be chaired by adjunct associate professor George Margelis of the TeleHealth Research & Innovation Laboratory at the University of Sydney. It will be held on March 14 at the Melbourne Convention and Exhibition Centre.
NSW takes a federated approach with $400m eHealth blueprint NSW will take a federated approach that balances centralised IT decisionmaking with localised input as part of its Blueprint for eHealth in NSW, recently released by Health Minister Jillian Skinner. The blueprint formally establishes a new eHealth NSW division as a separate entity within NSW Health. These developments were foreshadowed by Ms Skinner in July 2012 and most of the funds were allocated in the 2011 state budget. The blueprint details how the government expects to spend the $400 million already allocated to ICT programs, including on existing roll-outs such as Cernerâ€™s FirstNet EMR, the enterprise imaging repository (EIR) and
HealtheNet, the program that NSW Health is using to link hospitals to primary care and the PCEHR. The EIR is expected to be live in all districts by February 2014. Former NSW Health CIO Greg Wells said trials were currently underway to allow private specialists to access the public repository. New initiatives include the roll-out of the $43 million MetaVision ICU system, which NSW Health has dubbed the Intensive Care Clinical Information System (ICCIS), and a new Community Health and Outpatient Care (CHOC) integrated clinical and electronic medical record, costing $100 million. They also include the $85m phase two of the roll-out of
FirstNet to other hospitals and clinical specialties, which will include voice recognition capability, and new electronic medication management (eMM) systems, tenders for which are expected to be issued shortly and which have been budgeted to cost $170 million over 10 years. An inaugural CEO of eHealth NSW will be appointed by April, along with a chief clinical information officer (CCIO) to engage with clinicians. The plan also includes the development of a strategy for rural and remote districts, and the development of a Health Wide Area Network (HWAN), which will enable a clinical-grade network across 20 sites with significant increases in
bandwidth to speed up the transmission of data. There are also a number of corporate initiatives such as a new Asset and Facilities Management Performance Improvement Program (AFMPIP) costing
$12m, the $89m automated rostering system called HealthRoster that will link to payroll and HR and is due for a statewide roll-out by the end of the 2014-15 financial year, and a new $22m Incident Information Management System (IIMS).
There will also be a single staff directory and the inclusion of health in NSW’s all-of-government data centre reform program known as GovDC. The cost over 10 years of all of these systems combined is $1.5 billion.
NEHTA resurrects troubled clinical leads program under new name The National E-Health Transition Authority (NEHTA) has established a new team of clinical governance advisors, following the mass resignations of the organisation’s former clinical leads team in August last year. NEHTA’s clinical governance unit (CG) has also taken on a new role and function, covering two sub-units of clinical safety and clinical functional assurance. It is headed by three senior clinical governance advisors, one of whom is former NEHTA clinical lead John Aloizos. According to documents seen by Pulse+IT, NEHTA has contracted 18 clinicians dubbed ‘clinical governance advisors’ (CGAs), “who will assist NEHTA specifically in relation to clinical safety, quality, functionality and useability as well as contributing to product development”. NEHTA claimed that the role of the CGAs is
“different to that of the former clinical leads”, who included former AMA president Mukesh Haikerwal and RACGP representative Nathan Pinskier. “The [CGAs’] role is to understand the views of the profession (e.g. by attending NEHTA stakeholder meetings) and bring that into some of the detailed design work to support the NEHTA technical teams to work within the agreed parameters of clinical experience,” NEHTA said. The CGAs are “clinicians with specific expertise that can support NEHTA with product design and development work. Their role is to establish, confirm, document and review all processes that impact on clinical safety and functionality.” CGAs who attend any stakeholder meetings will not be there to “present views, but to listen, understand and, where feasible, draw out some
of the consequences of statements from the profession to better understand and develop robust products over time”. Part of the role includes participating in the testing of new NEHTA products for clinical functionality and safety, providing clinical strategic advice on eHealth to NEHTA at the executive and CEO level and providing clinical governance input into key NEHTA programs like the clinical usability program (CUP). It will also include occasional participation “in external forums with the peak bodies to listen, understand and draw out some of the consequences of statements from the profession to better understand and contribute to the development of sound clinical positions that support and allow NEHTA to develop safe, useful and useable products, services and solutions”. NEHTA declined to comment.
App joins the fight against anti-vaxers The Australian Academy of Science has released a Science Q&A app to provide the scientific evidence for immunisation and help dispel the myths promulgated by antivaccination groups. Available for Android and Apple tablet devices, the app is based on the academy’s Science of Immunisation booklet, published last year and distributed to 7000 GPs. It is also available online at the academy website. Launched by academy president Suzanne Cory, immunologist Gus Nossal and AMA president Steve Hambleton, the app presents evidence-based medical and scientific information, answers common questions and dispels myths about immunisation. Dr Hambleton said it was another useful tool for community GPs, who are the public face of immunisation for most Australians. “The app features strong scientific evidence, clear explanations, and easy-to-understand language that will reassure people, including conscientious objectors, about the safety and efficacy of immunisation,” Dr Hambleton said. “It is an important new resource that will help dispel the non-scientific myths and misinformation circulated by antivaccination groups in the community.” Professor Cory said the goal in developing the app was to increase understanding about immunisation and to summarise in lay language, how the immune system works, how vaccination works, how vaccines are made, and to provide a summary of the benefits and risks. The app also provides access to the academy’s Science of Climate Change booklet. It is available from Google Play and the App Store.
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Rural Health Channel to go off air for lack of funding The Rural Health Education Foundation (RHEF) has been forced to close its doors and cease operating the Rural Health Channel, with the not-for-profit organisation saying it was no longer financially viable following a reduction in government-contracted work. The RHEF has been in operation since 1995, and in May 2012 began broadcasting the Rural Health Channel over Optus’ Aurora digital satellite to areas that cannot receive terrestrial digital television. It was the first narrow-cast telecaster launched on the government’s Viewer Access Satellite Television (VAST) platform and was funded by a $300,000 federal grant. In addition to documentaries and forums, the channel broadcast programs and health education information on behalf of government, professional organisations and health associations. In 2012 it produced two CPD-accredited online learning modules for the RACGP. The foundation was funded to deliver eight continuing medical education programs to rural health and medical professionals by producing, broadcasting and distributing television-based distance learning. A spokesman for Assistant Minister for Health Fiona Nash, who has responsibility for rural health, said the minister was aware that the organisation would be closing, including no longer broadcasting programs on the Rural Health Channel, but that it was not her decision. “The Foundation is an independent organisation and its decision to cease operations has not been generated by any withdrawal of funding by this government,” the spokesman said. “The government’s commitment to frontline health services in regional and remote communities continues unabated.”
Glitch in PCEHR allows allied health to upload shared health summaries An apparent glitch in the security arrangements for the PCEHR means that allied health practitioners are able to upload shared health summaries through general practice software, contrary to the rules of the PCEHR Act. The act states that only medical practitioners, registered nurses or Aboriginal health workers, as the patient’s nominated healthcare provider, are allowed to create and upload a shared health summary. Allied health practitioners are restricted to viewing the record and uploading event summaries. Pulse+IT has learned that despite this restriction, it is still possible for an allied health practitioner to upload a shared health summary through GP software, using their own Healthcare Provider Identifier – Individual (HPI-I). A general practitioner who wished to remain anonymous said that an exercise physiologist working with his practice had been able to achieve the feat. The GP, who is also the designated responsible officer (RO) for the practice, was sitting with the exercise physiologist and training him on the system. He
decided to test it by getting the physiologist to write and post a shared health summary. The physiologist is registered within the practice software and had recorded his HPI-I in the system. The GP used his own PCEHR as a test. The shared health summary was created and uploaded, and it appears in the record’s audit log with the physiologist’s name and HPI-I.
“It seems to be relying on the honour system, which I suppose is always going to be the safeguard.”
required the physiologist to attest that he was a treating health professional and the nominated healthcare provider for the patient, and that he had prepared the shared health summary in consultation with the patient. “All you need to do is tick the box that says yes and it went up,” the GP said. “A healthcare provider would have to knowingly tick the box [in contravention of the PCEHR Act] but it is still a problem because if you get a health professional who is busy, they might do the usual thing that people do when they come across a wall of text that says ‘I agree to the terms and conditions’. “Everyone just ticks the box and says ‘yes I agree with them’. It is a poor design basically.”
Under the GP’s supervision, the physiologist removed the document immediately after posting it. GPs are allowed to remove a document that they themselves have created, although they are not allowed to remove one created by anyone else.
The GP said both he and the physiologist were technically in breach of the act, but as the RO, the GP is the responsible party. “It seems to be relying on the honour system, which I suppose is always going to be the safeguard.”
The GP said that as the RO, he was actually trying to show the physiologist what he couldn’t do, so tested the software to see what would happen. He said the only safeguard was a challenge screen, which
The GP said that while the honour system would work as a safeguard, he was concerned that the glitch could be dangerous in large, multi-doctor practices that employ many allied health practitioners.
One-touch smartphone with motion analytics sets Indiegogoing Brisbane-based start-up company Ollo Mobile is getting ready to release a one-touch smartphone aimed at older people, having reached its target on crowd-funding site Indiegogo.
The company is aiming for a global market, and according to co-founder Hugh Geiger, is in talks with telecommunications carriers to develop a global SIM card so it can be used anywhere.
CloudPhone also includes an accelerometer to detect falls, as well as lifestyle analytics that will allow family members to monitor an older person’s movements over a day or month and be alerted if there are changes.
The device can be worn around the neck, on a keychain or put in a pocket. Co-founder and company CTO Ken Macken said CloudPhone is designed for people who may have trouble using other mobile devices such as the elderly and the disabled, but can also be used to keep track of and communicate with children.
The CloudPhone has voice-activated dialling and contains indoor and outdoor geolocation, conference calling capabilities and is waterproof, so it can be worn in the shower. It also has a 10-day battery life and a plug-free charging cradle. Having put their own money into its development and raising over $50,000 on Indiegogo, Ollo Mobile aims to have the first models ready for release in July.
The device was a national finalist in the start-up category at the 2013 iAwards, and also won cloud hosting firm Rackspace’s Small Teams Big Impact (STBI) competition in Sydney last year. Mr Geiger said the company had been set up in response to an injury to a family member. He said the difference between CloudPhone and popular devices such as panic alarms is that it is a communication device.
“With panic alarms, a call centre sits in the middle between the family and the elderly person,” he said. “You don’t need to have a call centre – the elderly person just presses a button on the device and we connect the whole family to talk to the person.” “If you have a fall you might not be able to articulate your location so there will be geolocation with WiFi and it will show the family on their phone where the person is.” The accelerometer also allows family to constantly monitor the person’s activity and map it throughout the day, month and year, showing how often they are inside or outside and how physically active they are at different times of the day. “We are going to map that against their medication and care, so if you get a different doctor, what was the impact on the level of wellness of your mother when she changed care provider or when she changed blood pressure medication,” he said. “She may feel ... less well, and that might translate into less physical activity and that can be a leading indicator of her health declining. As a family, that might not be noticed until it’s too late.”
Adverse drug event reporting from within medical software The Therapeutic Goods Administration (TGA) has invited medical software vendors to take part in a project to build a web service to make adverse drug event reporting easier. The pilot project is due to run until April, when the TGA plans to make the web service available for free to software vendors. It will be compatible with both mobile and desktop devices. Vendors involved in the project will need to develop a reporting interface within their software and to test the transmission of reports using the web service from the software to the TGA in XML format. The TGA said reports of adverse events from health professionals are essential to its safety monitoring activities, but that the time required is a significant barrier to reporting by health professionals. “Providing an adverse event reporting mechanism in medical software, particularly one that allows reports to be automatically populated from clinical record data, has been suggested as a way of reducing the time required to find, complete and send reporting forms,” the TGA said. “Any company providing software to health professionals – such as general practitioners, hospital and community pharmacists, specialists and nurses – who submit reports of adverse events to medicines is welcome to participate.” It said the development of the web service was one of a number of projects that the TGA is currently undertaking to encourage adverse event reporting by health professionals and consumers. It is doing this by improving access to methods for reporting, promoting the reporting system, and educating health professionals about how and why to report, it said.
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IT governance, messaging standards released Standards Australia has published a new standard to assist organisations with appropriate governance frameworks for large IT projects, as well as three standards and one technical specification for secure messaging. The new AS/NZS 8016 is not eHealthspecific but is based on an ISO corporate governance model. Project editor Max Shanahan said the standard was designed to raise awareness among boards and executives of their governance responsibilities, and to assist members of governing bodies, who are required to evaluate business cases for major IT-related investment decisions without having the benefit of a technology background. The organisation has also published four secure message delivery (SMD) documents that have been designed to incorporate new practices and technologies into the eHealth messaging system. “The documents represent a standard system which makes use of existing internet infrastructure to transfer health documents accurately and securely,” Standards Australia CEO Bronwyn Evans said. She also said they provide an opportunity for broad adoption and implementation, as an essential part of the secure messaging infrastructure now being widely sought across the health sector. The standards were developed by the IT-014-06 health informatics messaging subcommittee, which is funded by the federal Department of Health. The secure messaging standards are available for free from Standards Australia’s eHealth site. AS/NZS 8016 is available for purchase from SAI Global.
Gulf between patients and doctors over electronic medical record access An Accenture survey of consumer attitudes towards patient access to electronic medical records has shown that 78 per cent of patients believe they should have full access, but only 22 per cent do so. The survey of consumers follows one taken in late 2012 of doctors’ attitudes, in which only 18 per cent of doctors believed patients should have full access to their medical records. While the consumer survey was more about attitudes than trying to find out if patients were actually asking for more access more frequently, it did bring up an interesting finding, which was that 47 per cent of Australian consumers without online access to
their medical records would be willing to change doctors to achieve it. The Accenture survey found that this percentage rises to 55 per cent among consumers under 55 years of age without online access to their records. Leigh Donoghue, managing director of Accenture’s health business, said an impetus behind doing the consumer survey was the results of the previous one, which indicated that Australian doctors have more conservative attitudes towards patient access than other countries. “We were really interested in how patients’ expectations compared with doctors’ views,” Mr
Donoghue said. “There is a significant gap. What also comes through is that younger consumers have higher expectations in terms of online access, along with higher income consumers. “That makes sense – each of these groups is IT literate and extensive users of online services – but the real challenge is to engage the older people who are going to become chronically ill unless they start to change some of their behaviours. “Access to medical records has to be a part of empowering people to take more responsibility and be active participants in their own healthcare. That’s why we have to start to change
some of the attitudes around patient access and involvement.” Mr Donoghue said Australian consumers differed from those in countries like the US and Brazil, where the expectation of online
access to medical information was higher. “When it comes to healthcare [in the US] you have more direct competition and the innovation that comes with that, such as the ability to get repeat prescription
refills online or wellness services via mobile health apps. “We are not wildly different from the UK, which has similar characteristics in terms of consumer experience and expectations.”
Consumers happy to share records, but wary of online A survey by business consulting firm Infosys on consumer attitudes towards sharing data online found that 92 per cent believe that doctors should have ready access to patients’ electronic health information. The survey of 5000 consumers, 1000 of whom were Australian, also found that consumers were confident in the security of their medical records and were comfortable sharing personal information with their doctor. However, only 60 per cent say they are willing to share healthcare information online. Allen Koehn, public sector general manager for Infosys in Australia, said the relative reluctance to share health information online was probably due to a conundrum facing providers and governments. “My personal healthcare information is very personal, and you could argue that it’s even more
personal than financial data, yet I own it,” Mr Koehn said. “The government doesn’t own it and the insurance companies don’t own it, I actually own it, but I probably have the least amount of control over health information compared to all of my personal information. “I think that is part of the conundrum: certainly when you go to the doctor’s office you are more than happy to sit there and speak with the doctor about very private information, but it’s another thing to get onto a government website or even a private insurer’s website and put private information out there.” The Infosys study did find that consumers were interested in using apps for their healthcare, with 70 per cent interested in apps that helped them track their health goals, 73 per cent for helping them stick to their doctor’s treatment plan, 76
per cent to communicate with their doctor’s office, and 75 per cent to coordinate appointments with their doctor. However, they were much less interested in using apps to share their healthcare data with their doctor. “There are more apps coming out where you can actually start doing business with government or doing business with your private health insurer, but if you look at what’s available on the market now, there are a lot of apps that are superficial. “I don’t think there’s a significant amount of apps available yet. That could be a reason why: there just aren’t the apps available that people have seen and become used to and trust. If I go to my doctor and he says I’d like you to start using this app so that I can monitor your progress and we can communicate, that’s a different story.”
Software to test cognitive impairment at point of care Computerised cognition testing software that uses an online deck of playing cards to detect early signs of mild cognitive impairment (MCI) and Alzheimer’s disease can also gauge the nature and magnitude of the impairments. The Cogstate Brief Battery (CBB) is a set of validated tests developed by Australian company Cogstate that has been commercialised as Cognigram and is now being used in Canada as a point of care dementia test. Through an agreement with Merck Canada, there are now 20 testing centres using the technology, with more than 580 GPs registered to use Cognigram. The CBB tests attention and reaction times as well as learning and memory. In previous research, it was shown to be able to detect cognitive impairment in Alzheimer’s and in assessing cognitive changes in the preclinical stages of the disease. This research showed it could be a useful screening tool to assist in the management of cognitive function in clinical settings. In new research published in BioMed Central Psychology, the CBB was able to show the nature and magnitude of cognitive impairments in MCI and Alzheimer’s. The tests use a deck of playing cards as their focal point, but no knowledge of any card games is required. Patients simply answer yes or no to questions when cards are displayed. The results showed that both the MCI and the AD groups performed significantly worse on both composites than the healthy adults. Also, the AD group’s learning/ memory score was significantly lower than the MCI group, demonstrating the presence and progression of the memory decline caused by the disease.
Events March 19-20 FEBRUARY
THE 5TH ANNUAL NATIONAL RECORDS AND INFORMATION OFFICERS’ FORUM Melbourne, VIC p: +61 2 9887 5001 w: www.himaa2.org.au
7TH ANNUAL HOSPITAL BED MANAGEMENT & PATIENT FLOW CONFERENCE
4TH ANNUAL HOSPITAL PATIENT COSTING CONFERENCE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
CIO’S NEW ROLE: LEADING DIGITAL TRANSFORMATION! Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events
20-21 FEBRUARY 2ND ANNUAL NATIONAL FORENSIC NURSING CONFERENCE Sydney, NSW p: +61 2 9080 4090 w: www.healthcareconferences.com.au
20-21 FEBRUARY 5TH ANNUAL NATIONAL DEMENTIA CONGRESS Melbourne, VIC p: +61 2 9080 4090 w: www.healthcareconferences.com.au
Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
HISA’S 2014 SYDNEY INTERNATIONAL WOMEN’S DAY BREAKFAST Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events
HISA’S 2014 MELBOURNE INTERNATIONAL WOMEN’S DAY BREAKFAST Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events
HISA WA COMMITTEE MEETING Perth, WA p: +61 3 9326 3311 w: www.hisa.org.au/events
DIGITAL HEALTH SUMMIT Melbourne, VIC p: +61 2 8908 8555 w: www.con-nect.com.au
5TH ANNUAL CLINICAL DOCUMENTATION, CODING & ANALYSIS CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
HISA VICTORIA’S PROFESSIONAL DEVELOPMENT EVENT Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events
24-25 MARCH THE 15TH ANNUAL HEALTH CONGRESS 2013 Sydney, NSW p: +61 2 9080 4307 w: www.informa.com.au
25-26 MARCH 3RD ANNUAL ELECTRONIC MEDICATION MANAGEMENT CONFERENCE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
5TH ANNUAL NATIONAL DISABILITY SUMMIT Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
HEALTH FACILITIES DESIGN AND DEVELOPMENT Sydney, NSW p: +61 02 9229 1000 w: www.austhealthweek.com.au/hfdd
4TH ANNUAL DEVELOPING THE ROLE OF THE NURSE PRACTITIONER CONFERENCE Melbourne, VIC p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
HEALTHCARE EFFICIENCY THROUGH TECHNOLOGY Sydney, NSW p: +61 02 9229 1000 w: www.austhealthweek.com.au/hfdd
AUSTRALIAN TELEHEALTH CONFERENCE Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/atc2014
HEALTH-E-NATION Sydney, NSW p: +612 4365 7500 w: www.health-e-nation.com.au
BIG DATA Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/bigdata2014
HISA VICTORIA’S PROFESSIONAL DEVELOPMENT EVENT Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events
MHEALTH SUMMIT ASIAPAC Sydney, NSW w: www.mhealthsummit.org/asiapac
HIC 2014 Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/hic2014
HISA VIC COMMITTEE MEETING Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events
THE 11TH ANNUAL FUTURE OF THE PBS SUMMIT Sydney, NSW p: +61 2 9080 4307 w: www.informa.com.au
HISA VIC COMMITTEE MEETING Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events
10-11 JUNE THE NEW ZEALAND HEALTHCARE CONGRESS Auckland, NZ p: +64 9 917 3653 w: www.healthcarecongress.org.nz
HISA WA COMMITTEE MEETING Perth, WA p: +61 3 9326 3311 w: www.hisa.org.au/events
Save the date 22-23 JULY
HISA WA COMMITTEE MEETING Perth, WA p: +61 3 9326 3311 w: www.hisa.org.au/events
19-20 MAY HIMSS AUSTRALIA CONFERENCE Sydney, NSW w: www.himssasiapac.org/aus14
NURSING INFORMATICS AUSTRALIA CONFERENCE Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/hic2014nia
RURAL DOCTORS ASSOCIATION OF QUEENSLAND 25TH ANNUAL CONFERENCE Brisbane, QLD p: +61 7 3221 4444 w: www.rdaq.com.au
AUSTRALIAN HEALTHCARE WEEK Sydney, NSW p: +61 02 9229 1000 w: www.austhealthweek.com.au
ITAC 2014 Hobart, TAS p: +61 8 8981 5119 w: www.itac2014.com.au
24-25 JULY 4TH ANNUAL NATIONAL HOSPITAL PROCUREMENT CONFERENCE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
25-26 AUGUST 15TH INTERNATIONAL MENTAL HEALTH CONFERENCE Gold Coast, QLD p: +61 7 5502 2068 w: www.anzmh.asn.au/conference/
RACGP NSW & ACT FACULTY’S MEDICAL RECEPTIONIST COURSE Sydney, NSW p: +61 2 8484 0792 w: www.australiandoctor.com.au/events
TBC SEPTEMBER EHEALTH INTEROPERABILITY CONFERENCE Sydney, NSW p: + 61 2 9080 4090 w: www.healthcareconferences.com.au
HIMAA AND NCCH 2014 NATIONAL CONFERENCE Darwin, NT p: +61 2 9887 5001 w: www.himaa2.org.au/conference
Online Calendar: To view a comprehensive list of eHealth, Health, and IT events, visit: http://www.pulseitmagazine.com.au/events
BOOSTING THE UPTAKE OF TELEHEALTH The volume of telehealth services delivered has not met expectations, and just installing technology does not raise uptake on its own. Telehealth can be boosted by developing new models of care, building clinician acceptance, and expanding to include chronic disease management in the home.
DR VICTORIA WADE BSc, DipAppPsych, MPsych, BMBS, FRACGP Vice president, Australasian Telehealth Society email@example.com
For over 20 years, enthusiastic individuals have predicted that telehealth is on the verge of becoming a major new way to deliver healthcare, but the actual uptake around the world has been slow and fallen far short of these predictions. Many telehealth services are still in trial phase with no guarantee of sustainable operations. Roald Merrell, the editor-in-chief of the Telemedicine and e-Health journal, said that failure to adopt has dominated much of our scientific consideration of telemedicine in the last 20 years, and went on to ask why, when doctors have taken up use of the internet and mobile phones with alacrity, telehealth seems to be different.
The situation in Australia
About the author Dr Victoria Wade is a research fellow in the Discipline of General Practice at the University of Adelaide, and the clinical director of the Adelaide UniCare e-Health & Telehealth Unit.
view, some who have broadly advertised their availability to conduct video consultations have found that the time they have set aside for telehealth has not been fully booked. In the state health sector, governments are investing in video communication infrastructure, and clinical use is increasing, but typically these networks are doing around a few thousand consultations a year. This remains very low compared with the total volume of patient contacts. I think there are three ways to tackle this issue: look at the models of healthcare that work for telehealth, build clinician acceptance, and expand the funding to more delivery options.
Let’s consider the actual situation in Australia. In private medical practice, we’ve had Medicare item numbers for video consultations to rural areas and aged care facilities for 2½ years now, and about 87,000 telehealth consultations have been done. The numbers have gradually increased to over 5000 a month and about half of these are dual consultations, with both the GP and the medical specialist being with the patient at the same time.
Models of care that work for telehealth
Yet to put this in perspective, this is less than one video consultation a month per rural GP. From the specialists’ point of
This is the most common situation in private practice at present. This type of telehealth service is hard to grow and is
I studied over 30 telehealth services in Australia, and found that they basically fell into two types. The first is where clinicians fit a low level of telehealth activity into their usual practice; for example by conducting a handful of video consultations a month over infrastructure that is low cost or already paid for.
vulnerable to cessation because it is very dependent on particular individuals, rather than being part of usual workflow or other procedures. The second type is where the telehealth service is of a size where it needs dedicated staff time, both clinical and administrative. These are the sorts of resources that state governments have, so this is where most of the larger clinical and technical networks exist. It is worth pointing out though, that installing technical infrastructure alone does not create a telehealth service. At this larger although still modest scale, introducing telehealth changes who, when, where and how the healthcare is delivered, as well as altering referral pathways, so in most cases a new model of care needs to be developed. This takes time, usually more than is available in a short-term trial or project.
Building clinician acceptance Building acceptance is best tackled by telehealth champions, who are enthusiasts with vision and drive; you know who you are! My study of telehealth services went some way towards finding out what these champions actually did. Firstly, they convinced clinicians that telehealth is a legitimate way of delivering healthcare, by raising awareness of telehealth, referring to research showing that telehealth is effective, allaying fears about quality, safety and ethico-legal matters, and promoting telehealth as a usual, well-established mode of operation. Secondly, champions build relationships between clinicians, which is necessary because telehealth cannot be done in isolation, only as part of a system. This drives referrals, expands the number of clinicians using telehealth, and helps solve operational problems.
â€œThe alternative, which is used more in nursing and community care, is funding packages of care.â€? Dr Victoria Wade
Expanding delivery options Providing Medicare item numbers only for real-time video telehealth to a limited range of areas (rural, residential aged care and indigenous health) is very restrictive and has prevented expansion. Chronic disease management is the next big frontier yet there is no real funding model for telehealth here except for trial projects. Most patients need some sort of daily contact, whether this be transmission of their data, such as blood sugar levels in diabetes, or a daily video call for home medication management, or text messages for cardiac rehabilitation. It is an area where the feefor-individual-service as enshrined in Medicare does not work well. The alternative, which is used more in nursing and community care, is funding packages of care. It would be simple and transformative to encourage and allow all or part of the packages of care currently delivered to patients at home to be conducted by telehealth where appropriate.
TELEHEALTH FOR THE FUTURE ATC 2014 OVERVIEW
As Dr Tori Wade puts it, telehealth in Australia has more pilots than Qantas, so it is fitting that she will speak at the Australian Telehealth Conference (ATC 2014), being held in Melbourne in March, on the topic of sustainability in telehealth services. The conference has been organised by seven leading healthcare organisations, and will cover seven key topics.
KATE MCDONALD Journalist: Pulse+IT firstname.lastname@example.org
While it is being hosted under the auspices of the Health Informatics Society of Australia (HISA), the Australian Telehealth Conference has been organised by seven different healthcare organisations under the theme of “Building for the future”. ATC 2014, being held at the Melbourne Convention and Exhibition Centre on March 19 and 20, will cover seven key topics: models of shared care, mHealth, the Australian Telehealth Strategy, rural and remote telehealth, telehealthcare in community care, aged care and care in the home, the transforming role of telehealth, and how connectivity has transformed the delivery of healthcare.
About the author
International speakers include Danny Sands, co-founder and co-chair of the USbased Society for Participatory Medicine, along with the chief consultant for telehealth services at the US Department of Veterans Affairs (DVA), Adam Darkins, who will discuss how the DVA has gone about making the home and local community the preferred place of care.
Kate McDonald is a senior staff journalist for Pulse+IT. Formerly the editor of Australian Life Scientist magazine, she has also edited industry titles Hospital & AgedCare and Nursing Review. Her interests cover health ICT, biotechnology and translational research.
This is an expanding field of in Australia as the population ages and the cost of institutional care rises. Speakers from two organisations that are investing heavily in telehealth in aged care and the community – aged care provider Feros Care and
community nursing provider RDNS – will discuss new models of support for these sectors. Feros Care’s CEO Jennene Buckley will discuss new support models for telehealth in aged care. Her organisation, which provides residential, day and respite care as well in-home respite and community care services in Queensland and NSW, has seen a quick return on its investment in a new video conferencing suite. Not only has it paid for itself in just over a year in terms of reductions in travel and accommodation expenses for care staff, but it has enabled the organisation to offer telehealth services as a point of difference. Feros Care is undertaking two federally funded trials, including the Technology Enabled Multidisciplinary Care Advisory Service (TEMCAS) pilot, which is using wireless and high-definition devices at three of Feros Care’s residential aged care facilities in northern NSW. The other, called the My Health Clinic at Home project, is aimed at seniors with chronic illnesses living in Coffs Harbour. This $2.8 million pilot is looking at new ways to use the NBN in healthcare and involves a touchscreen device with in-built video camera and peripheral devices to monitor health and wellness at home.
One of the aims is to see if it is financially sustainable in the long term. While the results aren’t available yet, Feros Care’s statistics are showing that it is a viable solution simply in terms of time saved for nurses having to travel to each home.
“We know it works but the problem is there is low uptake, fragmented services, and a lack of sustainability.”
This is an area that is also being explored by RDNS, which has been running a trial of Intel’s Home Guide device to manage medications for older people in their homes. The organisation is now looking for a new technology following Intel’s decision to withdraw the product from sale in Australia, but is confident that a viable replacement can be found.
Dr Ewen McPhee
The trial has been running since May 2012 and has won several awards. It is currently being evaluated by La Trobe University, but RDNS is keen for it to continue. The trial involves a daily video conference through the device with clients in their home, in which they are prompted to take their medications. A nurse at the RDNS call centre in Melbourne observes the client as they take their meds, and checks the medications pack to ensure it is correct. Stelvio Vido, executive general manager for projects and business development with RDNS, will outline the project at ATC 2014.
More pilots than Qantas Adelaide UniCare E-Health’s clinical director, Dr Tori Wade, is understood to be the originator of the ‘more pilots than Qantas’ pun. She will discuss sustainability and vulnerability in Australian telehealth services at the conference in the models of shared care session. She will also take part in a Q&A panel on models of shared care and the provision of telehealth in rural and remote areas, along with Queensland GP Ewen McPhee, medical oncologist Sabe Sabesan, Royal Perth Hospital clinical nurse consultant
Beth Sperring, and Angus Turner, director of Lions Outback Vision. Associate Professor Sabesan was able to show in published research last year that the Townsville Cancer Centre’s teleoncology service has achieved net savings through major reductions in travel costs for patients and specialists, which can then be redirected into enhancing rural health resources. Dr McPhee is a high-profile advocate of telehealth in the primary care sector in rural Australia, and has worked closely with the Queensland Health Minister, Lawrence Springborg, and Queensland Health to develop a four-year, $31 million rural telehealth service for the whole state that aims to embed telehealth provision in all hospital and health services as well as in primary care. In August last year, Mr Springborg announced seven evaluation sites for the service, which will use existing and underused infrastructure to improve telehealth provision to people in rural and remote areas of the state. Mr Springborg told the Rural Medicine Conference in Cairns last year that there was an excellent telehealth network already available in Queensland, and he paid tribute to his predecessors as health ministers for having put it in place. However, he said it was underused and clinicians were not confident it was being supported, something he aims to change.
“From my perspective, what is most important now is to ensure that we invest in the uptake and provide patients and clinicians with the surety that it is going to be reliable,” Mr Springborg said. “That is why we have invested $31 million over four years to ensure that we put in place the coordination processes and that there is confidence that is going to be reliable. We are about supercharging it, and that’s what we want to do.” Dr McPhee told the conference that the telehealth having more pilots than Qantas pun was appropriate, so it was about about time it started to take off. “We know it works but the problem is there is low uptake, fragmented services, and a lack of sustainability,” Dr McPhee said. “Our vision is that we are going to be embed telehealth in everyday care. It is going to be the way we do business. We are going to design a telehealth system for the whole health service, not just Queensland Health, not just private enterprise. “If we want to give access to every primary care clinic – whether it is the Flying Doctors Service, whether it’s a bush clinic or my practice in Emerald – we have to embed this into every general practice and hospital in Queensland. It’s a challenge but I think we can do it.” For more information on ATC 2014, see http://www.hisa.org.au/page/atc2014
GETTING ON BOARD
TELEHEALTH INCENTIVE ENDS After three years, the Telehealth On-Board Incentive program will come to an end on June 30, and no more claims will be allowed after December 30. However, barring a new policy announcement or even more savage cuts in the May budget than expected, the Medicare rebates for telehealth consults between specialists, GPs and patients looks set to continue.
KATE MCDONALD Journalist: Pulse+IT email@example.com
In June 2011, then health minister Nicola Roxon announced a $620 million telehealth initiative that would see specialists, general practitioners and aged care facilities eligible for a one-off $6000 incentive to take up telehealth over the next four years. Called the Telehealth On-Board Incentive, it was devised to encourage healthcare practitioners to invest in the necessary technology to conduct video conferences, although no restrictions were placed on what equipment could be bought. Along with the on-board incentive came new MBS item numbers that allowed specialists to claim a loading of 50 per cent and GPs 35 per cent, with the derived fee added to the base item fee, for video consults. New MBS items were also introduced for patient-end services, allowing nurse practitioners, midwives, Aboriginal health workers and practice nurses to provide face-to-face clinical services to the patient during the consultation with the specialist. In addition, the government introduced a Telehealth Support Initiative, which funded the development of a range of training supports, tools and guidelines to facilitate online telehealth consultations and to
promote uptake. The RACGP developed a range of guidelines and protocols for setting up and using telehealth in the primary care environment, while ACRRM has developed a comprehensive directory of telehealth providers. In 2012, the government also offered funding through Medicare Locals for telehealth support officers, most contracted for a year, to assist general practices to offer telehealth services, as well as build links between local hospitals and aged care facilities to provide specialist consults direct to the bedside. Back in 2011, the government was optimistic that the range of incentives would increase the use of telehealth, and it set a goal of 495,000 telehealth consultations by July 2015. However, whether through budget pressures or the governmentâ€™s stated reason that it wanted to get the uptake moving faster, in 2012 it announced that it was not only tightening the eligibility for the MBS items, but was cutting the onboard incentives plan by one year. In the original plan, incentives were to be reduced from a lump sum payment of $6000 in 2012 to $4800 in July 2013, $3900 in 2014 and $3300 in 2015. The payment
schedule was also changed so that a percentage was paid after the first consult, and the bulk after the tenth. While many saw the sense in cutting back on the incentive – which, anecdote has it, was not spent on much in the way of equipment, the majority of users plumping for Skype – the introduction of a 15km minimum distance between specialist and patient location was widely decried. It did not apply to residents of aged care facilities or patients of Aboriginal medical services, but it did mean that many GPs working in outer metropolitan suburbs and regional areas would now miss out. In June 2013, the Labor government said it would ask the Department of Health to canvass the option of allowing MBS rebates for direct GP to patient video consults, but with a change of government, that does not appear to have gone ahead. A tight-lipped Peter Dutton has not made any policy announcements since the election and it is probable that he won’t until after the May federal budget.
Facts and figures The Department of Human Services (DHS), which manages the administrative side of the telehealth scheme on behalf of the Department of Health, has confirmed that the on-board incentive scheme will end as planned on June 30. In advice to healthcare organisations, DHS says the Medicare rebates will remain.
“The government was optimistic and it set a goal of 495,000 telehealth consultations by July 2015.” Kate McDonald
more than 9200 providers. This includes 3200 specialists and 221 residential aged care facilities. The increase in telehealth service provision was steady – rising from 1809 services in the first quarter that the scheme was in operation to 16,524 in the same quarter the following year, and 22,610 in 2013 – but it seems unlikely that the target of 495,000 consults will be reached without further incentives. DHS figures show that of telehealth services provided to December 30, 2013: • 3208 specialists provided 92,969 services • 6043 general practitioners provided 50,684 services • 35 midwives or nurse practitioners provided 460 services • In total, 144,113 services were provided to 55,454 patients.
Healthcare providers have until December 30 to submit claims that are eligible for incentive payments, but they will not be paid to claims submitted after that date.
While NSW topped the list in the amount of services offered with 43,125 or 29.9 per cent, it was Queensland, which has a far smaller population, where the scheme seemed most popular. Queensland provided 42,751 patient services or 29.7 per cent of the total.
Medicare figures show that in the 2.5 years that the incentives program has been operational, over 144,000 services have been provided to over 55,000 patients by
Victoria provided 15.7 per cent, followed by WA with 9.4, SA with 8.1, Tasmania with 5.6 and the NT and ACT 1.3 and 0.2 per cent respectively.
The most popular specialties were: • Psychiatry – 28,614 services (511 providers) • Consultant physicians – 25,944 (1002) • Rheumatology – 9526 (108) • Paediatric medicine – 7505 (294) • Urology – 5034 (118) • Gastroenterology – 3637 (167) • Dermatology – 3495 (139)
While these figures are for telehealth services provided under the MBS, many hospitals and health services offer their own telehealth arrangements that are not claimed this way and are funded by the state governments. WA, for example, has a service funded by its Royalties for Regions program which sees emergency medicine consults provided after hours to small rural hospitals that don’t have medical cover. Queensland has a thriving telehealth network that is funded by a number of schemes, including a new $31 million rural telehealth network. The private sector is also playing a role. In addition to long-standing telehealth providers such as the not-for-profit Telehealth Solutions Australia, private sector entities such as GP2U, Consult Direct, Anywhere Healthcare and allied health service Telestrong are offering telehealth both as an MBS-funded service and for a fee to private patients.
INTERCONNECT IN RURAL TELEHEALTH PROVISION One of the most forceful arguments for investing in telehealth is its ability to allow people in rural and regional areas to have access to healthcare providers and services that they do not have today. However, when healthcare organisations and governments are designing telehealth services, it is essential to determine whether those services are appropriate given the broadband infrastructure they will be using, particularly when it comes to satellite.
KATE MCDONALD Journalist: Pulse+IT firstname.lastname@example.org
Some time next year, NBN Co will launch two geostationary satellites currently being built by Space Systems/Loral in California to provide a long-term solution to broadband provision for the remotest parts of Australia as part of the roll-out of the NBN. Managed by Optus, they will replace the interim satellite service NBN Co has been providing, which recently reached its full capacity of 48,000 connections and can no longer accept new users. CSIRO has been researching the implications of the different kinds of broadband on telehealth provision in Australia, particularly for areas classified as remote or very remote by the Australian Bureau of Statistics. These are areas that have known poor health outcomes and are those that will be served by satellite. In late 2012, CSIRO released a whitepaper on this very topic called “Caring for the Last 3%: Telehealth Potential and Broadband Implications for Remote Australia”. The three per cent refers to the percentage of the population in those remote area who will receive satellite broadband. Under the original NBN plan, another four per cent in rural areas would receive fixed wireless broadband, while 93 per cent were to receive fibre directly to their homes and workplaces.
While the latter figure has changed somewhat with the election of a new government and its plans to redesign the NBN in urban areas, the three per cent figure for satellite is likely to remain unchanged. There will be faster speeds than originally envisaged – the long‑term satellites were originally slated to deliver download speeds of 12 megabits per second (Mbps) and upload speeds of 1Mbps, but the previous government announced they had been boosted to 25Mbps download and 5Mbps upload – which will probably enable more telehealth services to be delivered. When it comes to satellite, however, there are technological limitations that cannot be overcome, and these limitations must be taken into consideration by healthcare organisations when they are designing telehealth services. That is not to say telehealth services cannot be delivered, but that organisations must plan carefully for what services are appropriate and what can be achieved. Sarah Dods, health services theme leader at CSIRO’s ICT Centre in Melbourne, says that while bandwidth will change depending on the upstream and downstream specifications, there is also the matter of latency, and this will not change.
CSIRO’s whitepaper, on which Dr Dods was the lead author, describes how satellite broadband transmits information using radio waves to satellites orbiting above the earth, which bounce the signal down to a satellite receiver. The geostationary satellites the NBN is building will remain in a fixed position orbiting the earth. “Satellite broadband is useful for very low population densities, as there are no infrastructure requirements other than a satellite dish for each connection point,” according to the whitepaper. “However, the path travelled by the signal is much greater than for fibre-optic or wireless connections, which can result in signal delay or latency. “Latency is the time delay for data to be transmitted between source and destination points. Latency has three elements: time to encode the data at the transmitter, time for the signal to be transmitted to the receiver, and time to decode the data at the receiver.” The signals travel at close to the speed of light, but with satellite, they have to travel much further, introducing additional latency, Dr Dods says. “The fundamental latency of the satellite service is largely set by the altitude of the satellite, which sets the physical distance the signal has to travel,” she says. “The new satellites will go into geostationary orbits around 36,000km above the earth. For comparison, the distance from Sydney to Perth for a ground-based fibre-optic connection is only around 3000km. So the satellite signal has to travel 20 times as far – up and back. “The extra bandwidth improves how much data can be packed into a unit of time (say one millisecond), but it doesn’t change how long it will take that one millisecond’s worth of data to travel up to the satellite and back.
“The fundamental latency of the satellite service is largely set by the altitude of the satellite, which sets the physical distance the signal has to travel.” Sarah Dods
“In terms of transport systems that we can relate to more easily, the bandwidth upgrade is like upgrading the highway between Melbourne and Sydney from a single-lane road to a four-lane highway. The signal has to travel the same distance, but the extra lanes will make the trip easier.”
Latency and human reactions Dr Dods says the extra bandwidth may help the move from standard resolution to real-time high resolution video for some telehealth services, particularly the upstream increase from 1Mbps to 5Mbps. For these signals, all the bits that make up each frame in the video stream need to transmitted in a burst, travel along the physical link, and then get reconstructed at the destination. “There are more bits in a high resolution frame, so the extra bandwidth will help transmit them faster and in a shorter burst,” she says. “The burst still has to travel the same distance, but the first and last bits of information will arrive closer together, so the picture also can be reconstructed faster.” For telehealth services, the amount of time a signal is going to take to get from one end of a connection to the other will have an effect on the delay, and what sort of services can be delivered. “The amount of time it is going to take to get from a rural
person’s house or medical centre to the NBN point of interconnect is going to be about a quarter of a second, best case,” she says. “This is because it has to go up to the satellite and back to the interconnect. Once you get into the backhaul, it is optical fibre and travels along the ground at 70 per cent of the speed of light to the switches in the network (usually in a city) that set up the connection to the other end. Then the signal travels from the switch to complete the connection.” If the end of the connection is by fibre – for example, a hospital – then the best case latency is around the same as human reaction time of around a quarter of a second. However, if the end is also a satellite connection such as a remote doctor’s surgery, and therefore both ends are using satellite, there will be “twohops” and the latency will double. “That is going to affect what kind of service experience you get when you try to connect to the other end of the network,” she says. Geosynchronous satellites orbit the planet every 24 hours from 36,000km above earth. To send a signal to the satellite and back takes about a quarter of a second. With two-hop satellites, the latency can be half a second in the best case scenario. “What it means is that if a remote patient
“If you are designing a service what you should think about is determining whether it is appropriate for different kinds of broadband delivery, particularly when it comes to satellite.” Sarah Dods
is connected over satellite, and he wants to talk to a rural health service, which is also connected over satellite, then he has to count it four times,” Dr Dods says. “The interesting thing is the human element. Generally our reaction time is a quarter of a second. If things happen faster than a quarter of a second, we think it is real time. If it gets longer than a quarter of a second, then we start noticing a delay and an unnaturalness when we are waiting for somebody to respond. “So we are down to looking at at least a one-second reaction time for somebody at the other end to respond to what he has been saying. That can feel decidedly odd. Imagine trying to do a remote consultation between a city specialist and a remote clinic over that. This is why we hear people talking about latency and why it matters.”
What can be achieved Dr Dods and her team have developed a framework that outlines what different elements of telehealth provision are achievable using satellite, and how health services might be able to put those components together. She urges healthcare organisations to look at what aspects of telehealth they can provide to remote areas now and in the future, despite the limitations of satellite.
These include old-fashioned telephonebased services, the use of social media for sharing content, asynchronous information sharing or “store and forward” – which facilitates the transfer of images or clinical data to be used at a later date – sensor monitoring and video streaming. “What we have then done is look at how much bandwidth you are going to need to do the different services, and what the interaction time you will need for them. If you look at sensor monitoring, you only need minutes, but if you are going to look at remote operation, you will need it to be very fast. “With low-resolution video conferencing, that will have a significant delay but it will be fine if you are just giving some advice to a person and telling them what to do, but it is a really bad thing to use if you are offering a telepsychiatry consultation and someone is recounting a fairly traumatic episode and you are trying to provide some real-time empathetic response. “You need to think about these elements. If you are at a remote clinic and you want to provide home-based monitoring for chronic heart failure, you might have some simple sensors, some video streaming for education and some low-resolution video conferences. These are choices that you will need to look at.
“If it is a city hospital providing the service, they have fibre so it is quite fast. If it is a rural clinic going to someone’s home, you are going to have a two-satellite hop and about a second or more latency designed into the system.” Dr Dods says that while bandwidth will improve, latency probably will not. “The interaction timescales aren’t going to change in the same way as bandwidth. I don’t think we are going to be changing the speed of light any time soon and I don’t think we are going to be changing human interaction time anytime soon. “We are particularly interested in human interaction and how we can adapt to those limits, but there are some limitations that go against nature so we are going to walk away from them. “Telesurgery over satellite is not going to happen in anybody’s lifetime. You really have to think about that interaction aspect when you are looking at putting services together. “There is an assumption that broadband just works and if you can develop the service then it can just run over the infrastructure that is there. If you are designing a service what you should think about is determining whether it is appropriate for different kinds of broadband delivery, particularly when it comes to satellite.” Although the NBN plan is to cover the last three per cent of remote Australia with satellite-only access, over time there might be more use of dedicated wireless services targeting specific use cases such as telehealth as this technology becomes more cost effective. CSIRO has been doing significant research in this area particularly with its long‑running NGARA rural wireless broadband network project for remote communities. The organisation hopes to see this wireless option emerging over the next few years.
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TELEHEALTH MOVES TO THE BROWSER Telehealth provider GP2U recently released a new version of its iPhone app with in-built WebRTC functionality and is now using the technology to conduct video conferences between GPs, specialists and patients through its website. The company is also getting ready to make its presence a bit more public, having bedded down many aspects of its technology platform.
KATE MCDONALD Journalist: Pulse+IT email@example.com
Early last year, Tasmanian-based telehealth firm GP2U caused a few ripples in the medical press when it announced it was launching a paid service that would allow patients to see a GP via video conference. Called Skype2doctor, the service allows patients to make an appointment online for a video conference from home over Skype with a remote doctor, usually working from home as well. The idea is to allow patients to register to use the service, choose a GP by appointment time, location, gender, languages spoken or services offered, and to sit in a virtual waiting room until the appointment time. The GP can write a prescription for the patient if necessary and fax it to their nearest pharmacy, and can also transfer a medical certificate for the patient to print out, along with a copy of the consultation notes that can be sent to the patient’s regular GP. The GP sets their own fees for the consultation, and the patient pays by PayPal or credit card. While both the AMA and the RACGP raised doubts about the service, fearing it would disrupt the traditional GPpatient relationship, GP2U’s founder,
James Freeman, said at the time that Skype2doctor was merely an extension of a new mode of practice and would provide a mechanism for any Australian GP to deliver telehealth care to any patient. GP2U itself runs on the more ‘traditional’ model, providing a platform for GPs to consult with specialists under the Medicare-funded arrangement. Many of those specialists are part-time doctors who work from home, and Dr Freeman estimates that GP2U now does over 20 per cent of all Medicare-funded specialist telehealth consults in the country. Dr Freeman has spent several years building the technology platform behind both services, including building a secure online portal with 256-bit SSL encryption, an online practice management system stored behind a Defence Signals Directorate (DSD) gateway, and compatibility with Cisco, Lifesize, Mirial, Polycom, Skype, Spranto, Tandberg and Vidyo endpoints. It has also developed a method for DB4 assignment of benefits forms to be signed digitally, an automatic billing system for both private billing and Medicare bulk billing, and a secure store and forward system that allows sharing of clinical images and other files.
Patient to GP For the direct patient to GP service, however, Dr Freeman knew that the ability to order prescriptions electronically was going to make or break it, so he has developed a way in which the doctor can automatically fax a script to the patient’s pharmacy, where the medications can be collected by the patient at their convenience or delivered to their home by courier. A paper PBS script can also be posted to the patient. GP2U has signed agreements with Terry White Chemists and Priceline Pharmacies to provide the service. “It was clear that medication was going to be a key component of this,” he says. “You have to think about how you get medicines to a patient who is not in front of you.” Under current prescribing and dispensing regulations, scripts must be written on
“From the user interface point of view what we were shooting for was a video application that works as easily as answering a phone call.” Dr James Freeman
PBS paper in order for the rebate to be refunded to pharmacists, so GPs taking part in the service will simply prescribe in the normal manner. With prescriptions, patients are offered three distinct options, Dr Freeman says. “They can elect for the doctor to post the script to their home, allowing the patient to choose any pharmacy to have it filled.
“We’re really grateful to Google for their fantastic Google Maps API. What it lets a patient do is select a local pharmacy from the map and have the script immediately faxed through for pick-up. “As a third options patients can elect to have the prescription fulfilled online by terrywhitechemists.com.au, who will arrange for it to be home-delivered. In all cases the original PBS paper script, handsigned by the treating doctor, is delivered to the necessary location.” For GPs working either from home or offering telehealth consults from their surgeries, GP2U offers a full managed service, including the patient management system and online appointment bookings. When the GP lists their free appointments, it will also list the fees charged. The PMS looks and functions exactly like common GP desktop software, and the only difference is that it’s hosted in the cloud.
WebRTC While GP2U has predominantly used Skype in the past, Dr Freeman is now heading down the path of WebRTC, allowing patients to connect with a GP directly through their browser. WebRTC is a developing standard that will allow people to conduct video conferences and transfer images and documents in real
“It was clear that medication was going to be a key component of this. You have to think about how you get medicines to a patient who is not in front of you.” Dr James Freeman
time through common internet browsers without the need to download a separate application such as Skype. GP2U has reworked its iOS and Android apps, which allow patients to register, book, pay, video conference and get prescriptions through their phones, to also allow the video conference to be done through WebRTC. A simple button has been added to the app to take the patient straight to GP2U’s virtual waiting room, with connections to the doctor via WebRTC proving faster and more secure than when using Skype. The GP2U website also now includes a WebRTC link in the virtual waiting room, so once a patient has logged in, they only need one click to attend the video conference. “If I want to see the doctor I go to the waiting room and I wait until the doctor comes to get me,” he says. “With our virtual waiting room patients simply wait until the doctor pops up on the screen. That’s pretty easy to explain. Go to the waiting room and wait for the doctor – you don’t need to explain anything much else as it all just works.” WebRTC currently only works natively with the Chrome or Firefox browsers, but it is also easy enough for users of Internet Explorer as IE will install Chrome’s Frame plug-in automatically. The WebRTC standard is not yet ratified and there is
still some wrangling going on – Google, for example, wants to mandate the VP8 codec, while others are still pushing for the more widely used H.264. This was initially rejected as it was a proprietary codec and involved licensing fees, but in October last year its owner, Cisco, announced the codec was being open sourced. People can still use WebRTC now, although it does require a signalling protocol in order to exchange IP addresses, and STUN (Session Traversal Utilities for NAT) and TURN (Traversal Using Relays around NAT) servers to traverse firewalls. Dr Freeman’s team built a WebRTC signalling server itself, but has now decided to outsource to a company called TokBox, which is backed by Spanish telecoms giant Telefónica. TokBox runs the OpenTok service and is one of many new start-ups concentrating on WebRTC. “One of the advantages of WebRTC over Skype is that because we are using a signalling server we’re not bouncing from machine to machine trying to work out where you are,” Dr Freeman says. “The bottom line is that it only takes a couple of seconds to connect so it’s much faster than Skype. “We are continuing with the process of trying to make it as easy as possible for people to video conference. We have really smooth registration processes with
patients that you can do on the phone or on the computer, it’s easy to understand as you just go to the waiting room, you click one button once to allow the camera, and it will just work. “One of my contentions about video conferencing is that it’s still too damn complicated, but if you look at the little iPhone app, you just press a button like answering a phone call and away it goes. And then once you’ve finished you press the hang up button. The volume control is the phone’s native volume control, it’s automatically on speakerphone, so there is almost nothing to go wrong. “From the user interface point of view what we were shooting for was a video application that works as easily as answering a phone call. One button to answer, one to hang up. Simple, but instead of a voice only call you have video as well.”
SIMPLE TECHNOLOGY TO DELIVER TELEHEALTH IN THE HOME
Flinders University is trialling the remote provision of palliative care, aged care and rehabilitation therapies for older people under its Telehealth in the Home project. In addition to a research focus on enhancing clinical services, the project is investigating how consumer-grade technologies such as iPads and the Fitbit device can be used to deliver care into the home.
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Flinders University’s Telehealth in the Home project was one of the successful bidders for the Telehealth Pilots Program, announced in 2013. Originally designed to test how the NBN could facilitate telehealth, the program has since been expanded to allow the use of other broadband access technologies such as 3G and ADSL.
One of the main focuses of the Flinders trial is how to effectively deliver telehealth using consumer-grade technologies. According to project manager Alan Taylor, the home is a very different environment than a healthcare facility, and healthcare providers wishing to provide that care will have to confront the use of consumer technologies.
Flinders University’s project, which is being run in conjunction with the Repatriation General Hospital and several specialist clinical networks, is investigating how to use online technologies to support aged and palliative care patients in the community. It also aims to evaluate the effectiveness of providing care remotely to overcome the issue of long travel times for therapists and nurses who visit patients at home.
“You need to give people something that is readily available, and we envisage technology moving in such a way that they will be doing it on their own iPads and over their own broadband plans, so we are testing whether consumer-grade technology is clinically adequate to deliver the services we want,” Mr Taylor says.
While this is relatively new for South Australia, there are a number of other projects currently being conducted around Australia into the effectiveness of telehealth in the home, many using high-tech devices that combine video conferencing with measurements of blood pressure, blood glucose levels and the like. However, one of the issues confronted when using these devices is their high cost, leading to questions about whether these services are financially sustainable.
iPads and Fitbits Flinders is leading the project in partnership with the SA Rehabilitation Statewide Clinical Network, the SA Older People Clinical Network and the SA Palliative Care Clinical Network. It uses a team approach that encompasses the patients’ carers, aged care facilities and specialist services along with GPs and other primary healthcare providers. The project aims to recruit up to 150 patients in the southern Adelaide region, most of whom will have received care at
“We are testing whether consumer-grade technology is clinically adequate to deliver the services we want.” Alan Taylor
Repatriation General Hospital and are keen to continue their treatment in their own homes. They are provided with a tablet device – predominantly an iPad – that is configured to be fully managed remotely. They are also provided with access to the Internet via 3G, ADSL or NBN, as well as an activity monitor linked by Bluetooth to the tablet. A suite of software applications is loaded onto the iPad, including video conferencing capability for direct video access to a nurse or therapist, access to self-management websites and an online self-assessment form, to be completed on a regular basis. Mr Taylor says the research team aims to evaluate the different technologies as the project progresses, including the different Internet access technologies. “We believe that there are significant differences in capabilities and obviously in coverage. Part of the research is directed at capturing that information, and that will help to both inform the technologists and the health service providers as to how to manage delivery of health services into the home. “The home is a very different situation and healthcare providers have to confront consumer issues and consumer technology. That is a substantial change that they need to think about because no longer can they say that they have quality of service absolutely guaranteed and available 24 hours a day. It doesn’t happen like that in the home.”
Mr Taylor’s team is investigating using Android and Windows platforms, but for historical reasons iPads were the first tablets used. They are simple to use and the patients in the trial seem to like them, and are providing feedback on how to improve their use. “One person did say that a problem she found with the iPad was that she couldn’t find the button on the iPad, and she suggested sticking a little white sticker on it so it would be visible,” Mr Taylor says. “Our aim is simplicity in this project, both with the devices being simple to use and also the applications, which are as far as possible one-button applications.” As many of the patients are older – the rehab patients are all over 65, although the palliative care patients can be any age – software icons and font sizes are kept large and attention is being paid to audio quality, Mr Taylor says. Video conferencing is conducted through the tablet, enabling the patients to have direct video access at scheduled times with their therapist or nurse. Palliative care patients are provided with a selfassessment application designed along clinically validated protocols that they or their carer complete daily. The software includes assessment tools such as the Karnofsky performance scale, which measures people’s overall ability to get on with daily life.
Patients and their carers are provided with a self-management website that has particular sets of information which may be useful in treating their condition, and the project team is currently building an exercise application which enables therapist to prescribe sets of exercises for particular rehabilitation purposes. “It will tell the patient what exercises they have to do and how long they should be doing them for,” Mr Taylor says. “It will show them on the video how to do the exercises. For example, if you break your arm and go into hospital, your therapist will tell you to do exercises where you have to hold your arm up in a particular way, but when you go home you can’t quite remember how they wanted it done. “We also give them a very simple activity monitor, the Fitbit, which is linked by Bluetooth to the tablet. It is fairly basic but it monitors their level of activity so we can see if someone hasn’t got out of bed for a day, which may indicate the need for an inperson visit or clinical follow up.” These sorts of devices are proliferating and some are better than others, but Mr Taylor says the project is choosing those that are easiest to use. Fitbit is also reasonably cheap, which comes in handy for the project’s finances as several have gone through the wash.
Accessibility Mr Taylor says the project team did consider more high-tech devices, but the main aim was to make telehealth provision as simple as possible. “There is a tension in this because some of our clinicians would like extra cameras, as they’d like to be able to monitor another parameter. That’s a lovely idea and it would certainly help some patients, but it would introduce a degree of complexity which would lessen the accessibility of the service.
“We are looking at this from several perspectives – the patient’s perspective, the carer’s perspective, the healthcare providers’ perspective – but we are also looking at efficiencies to be gained in the system. We are looking at whether telehealth is convenient, whether it motivates people, whether it makes people more aware of how they are living their lives. “Does it help the relationship that is established between therapists and their patients? Can older people use it? Should telehealth supplement or replace traditional face-to-face therapies? We are also looking at our existing business processes to see if they can be improved such as travel time, as well as at health
“[Fitbit] is fairly basic but it monitors their level of activity so we can see if someone hasn’t got out of bed for a day...” Alan Taylor
and safety and quality criteria. It’s important to understand that telehealth will change between specialities – each speciality has very different needs. “Part of the research is really to establish to what extent telehealth can play a part
or be used in the health service delivery model for these specialities. We are looking at very substantial changes in the way healthcare is delivered when it goes into the home, so we are essentially redesigning part of clinical services’ delivery.””
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TELEHEALTH RESEARCH GOES COMMERCIAL FOR AGED CARE
A Queensland-based research team that has developed protocols to support geriatric care using telehealth has established a new commercial business called RES-e-CARE for residential aged care facilities. Taking a high-tech approach to telehealth in aged care is considered essential for frail and often immobile elderly people, many of whom often have cognitive impairments.
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The University of Queensland’s Centre for Online Health (COH) had been researching and developing a number of programs in the fields of telemedicine, telehealth and eHealth since 1999, and through Brisbane’s Royal Children’s Hospital (RCH) has run a telepaediatrics service for the last 13 years. It also has a particular in interest in telehealth for aged care, and in association with the Centre for Research in Geriatric Medicine (CRGM) has developed a web‑based clinical decision support system that is used in hospital care for older people. The system uses a structured assessment overlaid with a number of processes to help interpret clinical observations. That system is also being used as part of a project that delivers healthcare to residential aged care through high‑definition video conferencing. In 2012, the research groups received a grant for almost $1 million from the National Health and Medical Research Council to conduct the project, which involves a four-year study of the clinical support system as well as what it calls “clinicalgrade” video conferencing technology into residential aged care facilities. The randomised control trial will see video conferencing technology deployed as a
mobile wireless device at the resident’s bedside and operated by a geriatrician from a remote telehealth studio, situated in a dedicated centre at Brisbane’s Princess Alexandra Hospital (PAH). The study will evaluate the impact of geriatrician-centred telehealth services on the health of residents, as well as other possible benefits such as staff engagement, skill transfer, appropriate medication use and transport costs.
Dedicated telehealth centre The COH is also closely involved in a $5.1 million Princess Alexandra Hospital Online Outreach Services (PAH Online) project, which was jointly funded by the federal and state governments under the Digital Regions Initiative program. Initially, it is delivering specialist services in the areas of cardiology, endocrinology, dermatology and geriatrics, with plans to extend these services into orthopaedics, infectious diseases and oncology. It has the capacity to conduct at least eight thousand assessments annually. The Princess Alexandra Hospital Telehealth Centre – a key ingredient of the PAH project – has been outfitted with high‑definition video conferencing technology to enable clinical telehealth provision. Studios are equipped with wall-
Professor Len Gray conducts a video consult with an aged care resident, with full access to the resident’s medical history and nursing notes.
mounted screens, high-tech lighting and sound equipment, and computer systems that allow access to resident/patient medical files. Len Gray, director of both the COH and CRGM and a consultant geriatrician at Princess Alexandra, is convinced that while PC-based systems such as Skype work well for general conversations, they are of insufficient reliability and quality for clinical diagnostic work, particularly when it comes to the elderly. “Clinical-grade technology is essential when performing a consult with an unwell
or frail older person,” Professor Gray says. “Conventional video conferencing allows the user to control the camera with better precision, compared with a smaller, hand‑held camera. “Our systems enable detection of subtle eye movements, observation of mobility patterns and reading of fine print, through the remotely controlled pan and zoom functions. “The need for this quality of video is important for working in nursing homes, where there will often be no medical support at the patient’s end.”
In addition to the aged care and PAH telehealth projects, the COH also works in a number of different areas in Queensland. In early 2013, it received funding from natural gas company QGC to develop and implement whole-of-community telehealth services in several towns in the Darling Downs region of southern Queensland. Three nursing homes in the region will have access to telehealth services, as will the public hospitals in Dalby, Chincilla and Miles. The project, called Health-eRegions, will also investigate mechanisms which support the delivery of telehealth
“Clinical-grade technology is essential when performing a consult with an unwell or frail older person.” Professor Len Gray
services into general practice. Part of the funding is being used to build a dedicated telehealth room at Dalby Hospital, based on similar configurations to those at the Royal Children’s and Princess Alexandra hospitals. Anthony Smith, the COH’s deputy director, says the high-tech approach to telemedicine in aged care will also be used in this project. Now, the COH team has established a new business called RES-e-CARE, offering an academic telehealth service on a commercial basis through the university’s commercialisation arm, Uniquest. RES-e-CARE will be offered to aged care facilities to provide regular geriatric consultations supported by purpose-built video conferencing studios, high-quality electronic data systems and clinical support staff trained in telehealth. The team also plans to add to its roster of consultant geriatricians and to expand the panel to other disciplines, for example psychiatry and dermatology, and to also investigate offering allied health and specialist nursing services on a cost basis through telehealth. Professor Gray says the idea is to take what his team has developed in its residential aged care research and offer it on a commercial, financially viable basis. “This is taking what we have learned about telehealth in residential aged care and testing what we conceive of as a business
model in the real world,” Professor Gray says. “It is halfway, in our minds, to a full commercial process.”
Affiliated geriatricians The basic clinical services that will be offered include an agreement with individual RACFs for access to specialist services via telehealth. Each facility will be allocated a geriatrician who will make regular virtual visits – generally once a week – and develop strong relationships with residents, nurses and visiting GPs. “Our business is a virtual private practice,” Professor Gray says. “We are setting up a practice with geriatricians as the key medical personnel, but during 2014 we expect to begin to add other disciplines that we think will be required by RACFs. That will depend on what we perceive to be the need and also of course the availability of the relevant specialists. “Central to our process though is that each facility will have its own geriatrician. The affiliated geriatrician will establish a relationship with the RACF so that geriatrician will get to know the staff and the residents and the GPs and become, if you like, a part of the staff. “This arrangement has similarities with private hospitals, where specialists base part or all of their practice around the hospital. Since all work is dependent on referral from GPs, it is critical that the specialist offer services that are perceived
by the GP, RACF staff and residents to be of high value.” Professor Gray is a strong advocate of using high-definition equipment for telehealth, particularly for older, less mobile patients and aged care residents. “Our standard is high-definition video conferencing with remote camera control. We are consulting at a distance with patients who have often have complex diagnostic problems. “A medical practitioner is not usually present at the patient end to assist in clinical examination. Residents often also have cognitive, hearing and visual impairments, that make interaction with low quality vision and sound systems problematic. “Current PC-based, low-cost solutions don’t currently provide the level of clinical capability that we require in a relatively unsupported environment.”
Allied health and nursing Part of RES-e-CARE’s offering will be to work through the technological challenges that face each RACF, and also to provide intensive training for nurses on how to prepare a case for the specialist. Professor Gray estimates that about twothirds of video consults to an RACF with a remote specialist take place without a GP in attendance. The RES-e-CARE team currently has three facilities fully equipped and working with an affiliated geriatrician, including the Cairns Aged Care Plus Centre in Brisbane, the Villa Vincent facility in Townsville and Masonic Care Queensland at Sandgate, and is scheduled to add 10 or 15 more over the next few months. It will then look at adding other medical disciplines, and other non-Medicare compensated services such as allied
health and specialist nursing that would normally be met at cost by the facility. “Allied health and nurse specialist services are probably most relevant to rural facilities that can’t easily access therapists and nutritionists,” he says. “For example, an aged care facility in outback Queensland may want access to a speech pathologist. The RACF would secure the service through RES-e-CARE on a fee-for-service basis. If they already have the telehealth infrastructure in place, that will mean the service will be relatively less expensive. “A key consideration in developing a service is to ensure that there is sufficient telehealth work demand for
“Since all work is dependent on referral from GPs, it is critical that the specialist offer services that are perceived by the GP, RACF staff and residents to be of high value.” Professor Len Gray
specialists. Once there are sufficient RACFs using RES-e-CARE, a wider range of specialties will have sufficient demand that involvement in teleconsultation will
become financially viable. We believe that once 10 RACFs are participating, quite a range of specialties will be in sufficient demand to begin engagement.”
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TELEHEALTH HELPS HOME DIALYSIS RATES Melbourne’s Western Health is running a trial of remote monitoring and video conferencing technology to improve the rates of home dialysis for patients with chronic kidney disease. Better known as the HUG trial, it aims to increase the amount of people dialysing at home, which is cheaper for health services and often more convenient for patients.
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The home therapy utilising telehealth guidance and monitoring (HUG) trial is the brainchild of the head of the nephrology unit at Western Health, Craig Nelson, and is based on similar projects conducted in the UK under its Whole System Demonstrator project. HUG project manager Catherine Blackmore told the Australian Centre for Health Innovation conference in Melbourne recently that the aim of the trial was to increase rates of home dialysis of Western Health patients from 15 per cent to the new benchmark set by the Victorian Department of Health of 30 to 35 per cent. “The rate [of home dialysis] does vary significantly if you look at different states,” Ms Blackmore says. “NSW has one of the highest instances of home dialysis at 38 per cent; Victoria has around 21 per cent but even in Victoria the rates from hospital to hospital vary significantly. “At Western Health, prior to HUG, our take up rates for home dialysis were 15 per cent. The Department of Health has set a KPI of 30 to 35 per cent of patients dialysing at home, so we have a lot of work to do to reach that.” The trial, which started officially in July 2013 with patient recruitment beginning
last April, is using a customised version of Tunstall’s ICP system to collect weight and blood pressure data for each patient. This is reviewed by a renal nurse every weekday, along with video conferencing capability so nurses can assist patients with correct needling and review exit sites for infection or inflammation. So popular has the project been that the nephrology unit’s dietitian is also conducting video conferences with patients in their own homes, remotely looking through their pantries and fridges and discussing foods with the patient, Ms Blackmore says.
Burden of dialysis The aim of the trial is not only to increase the amount of people dialysing at home – which is a far cheaper modality than centre-based dialysis, and is also more convenient for many patients – but also to reduce the number of people coming off home dialysis and returning to centrebased care. “In excess of 40 per cent stop dialysing at home because of social reasons,” Ms Blackmore says. “It’s often not really related to dialysis itself, but the burden of dialysis causing stress in so many aspects of their life. Often it is just too hard.”
The majority of Western Health patients need peritoneal dialysis, which requires them to dialyse every day, and to record their weight and blood pressure every day. Using the ICP system, the patients are taken through an easy to follow “interview” by the ICP device in their home. They are asked to take their blood pressure and then their weight, and are then asked a series of questions about exit site care, the look of their fluids and whether there were any problems overnight. The data is Bluetoothed to the device and then is sent to a secure portal, where the renal nurse is able to check on each patient’s data each day. “It is a secure data transfer; we spent a lot of time with the company to make sure that was the case,” Ms Blackmore says. “They do their interview, and then I log into the computer and have a look at that data. We analyse it, we interpret it and we make any clinical recommendations that we need to, and it is all done remotely.”
“We analyse it, we interpret it and we make any clinical recommendations that we need to, and it is all done remotely.” Catherine Blackmore
The patient’s file in the hospital system allows nurses to see by colour code if anything needs immediate attention or needs to be monitored. Patients can send messages to the system during the interview, and nurses can also write comments on the file. Nurses can also do video conferences with the patient – which has been useful particularly when the patient is first starting out on home dialysis and might still be unsure of needling or catheter exit site care – and messages can also be sent through the device to remind them if they have a doctor’s appointment or the like.
Ms Blackmore says the trial is only in its early stages so evidence of improved outcomes is only anecdotal, but there have been some successes. Using the video conferencing aspect, nurses were able to see inflamed exit sites on two patients, who were then brought back to hospital for treatment. Another patient showed persistent brachycardia. She was assessed and is now waiting for a pacemaker. “Some had persistent hypertension – there was a persistent pattern – so we could make some changes to medications,” Ms Blackmore says. One unexpected success was the discovery that one patient was functionally illiterate. He has since been assisted to continue with the program when his wife is not present by repeatedly going through the steps of setting up the machine and taking the measurements, which reinforces the process. He is now able to manage it on his own. For patients on haemodialysis with a fear of needling, video conferencing provides a way for nurses to support and reassure them and keep them at home. “It is bridging that gap,” Ms Blackmore says. The early results of the trial are showing good outcomes, with the rate of home dialysis up to 33 per cent. “It is very early in the trial but we are heading in the right direction.”
LODDON MALLEE SETS ITS SIGHTS ON TELEDERMATOLOGY CLINIC
Loddon Mallee Murray Medicare Local (LMMML) has recruited a second practice for a teledermatology clinic it is running in association with Royal Melbourne HospitaL, and is also looking to set up an oncology handover clinic for local residents and their GPs using telehealth, and is scoping out the viability of a telehealth-delivered pain clinic.
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Royal Melbourne Hospital currently runs a small teledermatology clinic with two general practices in rural Victoria, one in Echuca and the other in Shepparton. Led by dermatologist George Varigos, it is a bulk-billing service as it operates as a private clinic within Royal Melbourne and can therefore take advantage of Medicare’s telehealth rebates. The virtual clinic is held for one hour every Tuesday and consults with four to five patients per week. Loddon Mallee Murray Medicare Local (LMMML), which covers the Bendigo area, is now also taking part, signing up its second practice late last year, according to LMMML’s eTechnology coordinator, Phil Coppin.
“If there are more photos needed of the patient, these can be sent during the consultation,” Mr Coppin says. “They can have a discussion about the condition, medications, ongoing management and decide who will write the script – that means they can manage the scripts locally – and if required they then also make an arrangement to send the patient to Melbourne if they decide the condition needs follow-up and investigation. “The patient gets an initial consult, diagnosis and management plan as part of that first tele-visit, and if there are then any ongoing reviews, they are managed through the same sort of technology.”
Bendigo and its surrounding areas are in need of specialist dermatology services. Dermatologists currently visit Bendigo three days a week with some fly-in fly-out specialists visiting the larger centres in the region, but demand is still there.
Mr Coppin says it was one of the anomalies of the Medicare rebates for telehealth that specialists working in public hospitals had to in effect set up a private clinic in order for general practice to be able to claim the relevant Medicarefunded telehealth consults.
Professor Varigos and his team are able to provide an initial consultation to remote patients and GPs by using a combination of store-and-forward technology and realtime video. GPs can send a referral to the hospital accompanied by digital photos, and if the clinic accepts the patient, it can evaluate the photos beforehand and then set up a video consultation.
“LMMML is keen to work with Bendigo Health to deliver telehealth consultations as they have a large outpatient clinic environment that services the region, but one of the real issues is that they would have to set up their outpatient clinics as private practices with Medicare. The system is one of the factors holding back innovation in the telehealth space.
“I know that if using telehealth between the acute and primary sectors was easier to establish, so that all parties can claim appropriate payments, we would see cameras on every computer in every room and telehealth would be mainstream.”
“At this stage there’s no cost, which in the health environment is always a factor.” Phil Coppin
Oncology handover LMMML has recruited practices in the towns of Donald and Boort for the clinic and is using existing technology rather than investing in anything high-tech, Mr Coppin says.
most of our GPs have the equipment so we are hoping that this easy to use and freely available technology will encourage further practices to join.”
“We are not doing anything new and it will basically just be Skype. The Royal Melbourne has no issues with that and
He is also in the early stages of setting up a telehealth-enabled process for handover of oncology patients following discharge
from hospital. The region has a particular problem with skin cancer as it is a farming community, but like many other regions there is a problem with continuity of care between the acute and the primary sectors. “Across the country, patient handovers between the acute sector and the GP is fairly hands-off,” he says.
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“[I]f using telehealth between the acute and primary sectors was easier to establish ... we would see cameras on every computer in every room and telehealth would be mainstream.” Phil Coppin
“Often, the GP is left wondering about ongoing management, particularly with conditions like cancer, because of the nature of the illness and some of the emotional factors patients are dealing with. The hospital’s discharge summary is fairly sterile and the GP is left grappling with what this patient really needs.” Mr Coppin says he broached the idea with the Loddon Mallee Integrated Cancer Service (LMICS) of doing a clinical handover, much as would be done on a hospital ward.
When the patient is discharged, the oncologist would make an appointment with the treating GP to do a video consult, with the patient in attendance to discuss the admission, what the prognosis is and what the ongoing management issues might be. “Everyone said that sounded like a good idea, so we are about to pick a patient about to be discharged from the oncology department and set up our first telehandover with their GP. They’ll sit down to do the session and then we’ll review
the consultation by talking to the patient, the GP and the oncologist and see if they found any value and whether it was worth pursuing further, or whether it was nice but wasn’t really worth doing longer term. “In a large system like a hospital often the real issue is the change management. Even a seemingly simple change can have a significant ripple effect across the organisation. So even if it works brilliantly from a patient and doctor’s perspective, there is still some work to be done. Change management is always the hardest part of any technology intervention.”
Local solutions In addition to setting up specialist clinics, Mr Coppin has also been working with aged care facilities to improve the use of telehealth for the benefit of residents. He is also looking at how to overcome shortages of specialists in the area – particularly pain specialists and gerontologists – through the use of telehealth. “Delivering a hospital clinic using a specialist who could be located in Brisbane, Sydney or Melbourne via a telehealth consultation could easily be seen as bit unusual, but given the scarcity of some specialities, it may need to become part of business as usual.” Mr Coppin says most of the GPs in the Medicare Local area can use telehealth, but he would like to see greater uptake. He is also watching with interest developments in WebRTC, which he believes will be of great benefit to telehealth as it will provide multi-site capability and will be much easier for patients to use. “I think when the standard is actually ratified and becomes more mainstream, we’ll see it really take off. And at this stage there’s no cost, which in the health environment is always a factor.”
ACSS AAPM P: 1800 196 000 / +61 3 9095 8712 F: +61 3 9329 2524 E: email@example.com W: www.aapm.org.au The Australian Association of Practice Managers (AAPM) is a not for profit, national peak association founded in 1979, dedicated to supporting effective practice management in the healthcare sector. The Australian Association of Practice Managers: • Represents practice managers and the profession of practice management throughout the healthcare industry. • Promotes professional development and the code of ethics through leadership and education. • Provides specialised services to support quality practice management including advocacy, education, resources, networking, advice and assistance.
ACIVA E: firstname.lastname@example.org W: www.aciva.org.au The Aged Care IT Vendors Association (ACIVA) was formed in early 2010, a not-for-profit organisation, incorporated in NSW. ACIVA represents the residential aged and community care sectors and vendors at various national forums regarding strategic developments and eHealth. ACIVA members are residential aged and community care software vendors, industry benchmarking software, financial software, call-bell, hardware, networking, infrastructure and industry partners. Members are committed to furthering the interests of residential aged and community care in national forums to ensure eHealth and access to the personally controlled health record (PCEHR) becomes a reality for the aged care industry in the very near future. Contact: Emma Pate email@example.com
P: 1300 788 005 / +61 2 9632 0026 F: +61 2 9632 0096 E: firstname.lastname@example.org W: www.acsshealth.com ACSS provides innovative and customisable patient management software streamlining day-to-day operations for GPs, Allied Health, Specialists, Radiologists, Pathologists, Private and Public Hospitals. eClaims® — Comprehensive and robust appointment and billing system with digital/voice recognition capabilities, electronic reporting transmissions and HL7 PACS system integration. eClaims® Hybrid — A solution tailored to Hospitals and other health service providers including billing agents who lack online capabilities. eClaims® Hybrid is the interface solution for connecting you to Medicare and health funds through ECLIPSE. SimDay® — Proven PAS (Patient Administration System) specifically designed for day surgeries and private hospitals – Now with ECLIPSE integration.
P: +61 3 5335 2220 F: +61 3 5335 2211 E: email@example.com W: www.argusdca.com.au
P: +61 3 9023 0800 F: +61 3 9614 2650 E: firstname.lastname@example.org W: www.precedencehealthcare.com
Argus provides and supports Argus secure messaging software; a popular electronic solution that enables healthcare practitioners to exchange many forms of patient related information securely and reliably and to Australian standards.
cdmNet is the gold standard for managing chronic disease in Australian GP clinics.
Argus interfaces with most clinical software applications sending directly from within your letter writing facility or word processor and runs virtually invisibly in the background. Documents sent using Argus can be automatically added to electronic patient records; thus avoiding the need to scan or manually file them.
cdmNet helps practices take a systematic approach to the management of their chronically ill population. It simplifies collaboration with the care team and ensures regular follow up and review.
Argus is the messaging solution chosen by many Medicare Locals through the ARGUS AFFINITY program delivering eHealth strategies across Australia. With over 17,000 users Argus continues to grow in popularity by delivering highly secure messages, a reliable product, backed by outstanding customer service all at the lowest cost possible.
P: 1300 308 531 F: +61 3 9797 0199 E: email@example.com W: www.advantech.net.au
The medical range extends through: • Point-of-Care Terminals. • Mini-PC and Medical Imaging Displays. • Mobile Medical Tablets. • Computerised Medical Carts. • Patient Infotainment Terminals. Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.
cdmNet eliminates paperwork and makes compliance with Medicare requirements easy. It increases the productivity of the entire practice and allows evidence-based care to be delivered to all chronically ill patients. If you wish to use cdmNet to provide high quality care for all your chronically ill patients while increasing your revenues, contact us now. • See cdm.net.au/evidence
Cerner Corporation Pty Limited
Advantech’s medical computing platforms are designed to enhance the quality and efficiency of healthcare for patients and users alike. All of Advantech’s medical PCs match the performance of commercial PCs but are medically rated to UL/EN 60601-1 third revision, IPX1 drip‑proof enclosures and are designed to suit ward and theatre based applications. Advantech offers long term availability and support plus a proven track record of reliability.
University trials show cdmNet results in improved quality of care and better patient outcomes.*
Best Practice P: +61 7 4155 8888 F: +61 7 4153 2093 E: firstname.lastname@example.org W: www.bpsoftware.com.au Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD) • Integrated Best Practice (Clinical/ Management) • Best Practice Automatic SMS reminders Visit us at the following conferences throughout the year: • • • • •
BP Summit, 14-16 March GPCE Sydney, 23-25 May RDAQ Brisbane, 6-8 June GPCE Brisbane, 12-14 September RACGP Adelaide, 9-11 October
P: +61 2 9900 4800 F: +61 2 9900 4990 E: AsiaPacific@cerner.com W: www.cerner.com.au Cerner is one of the leading global suppliers of health care information technology solutions. Cerner’s mission is to contribute to the systematic improvement of health care delivery and the health of communities. Our vision of proactive health care management drives innovation in the development of effective solutions for today’s health care challenges, while creating a foundation for tomorrow’s health populations. Working with more than 4000 clients worldwide, Cerner is solving health care’s many challenges making sure the right people have the right information at the right time. Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data in Condition Management and Personalised Medicine • Connecting the community with personal and community health records
CONNECT DIRECT Pty Ltd Clintel Systems P: +61 8 8203 0555 E: email@example.com W: www.clintel.com.au The Specialist: A complete solution for your Appointments, Billing including Online Claiming and Clinical requirements in an intuitive scalable solution. Clintel provides systems to Specialist and Day Surgeries nationally. Powerful, highly configurable and easy to use, our systems mirror the needs and workflow of your practice and individual specialty. Our industry standard SQL database enables a true “paperless” practice. Our leading edge architecture is future proof, it is designed to meet changing requirements and offers first class reporting and analysis of clinical and business data. Standalone or networked multi-site installation which runs on both Mac OSX and Windows operating systems. Our support is first class, our philosophy is “whatever it takes”.
Cutting Edge Software P: 1300 237 638 E: firstname.lastname@example.org W: www.cesoft.com.au Cutting Edge produces affordable, intuitive billing solutions for Mac, Windows, Linux and iPad. Cutting Edge is ideal for practitioners who prefer to maintain control of their own billing from a number of sites. Cutting Edge Software is approved by Medicare Australia to manage your electronic: • Verification of Medicare and Fund membership • Bulk Bill and Medicare claims • DVA paperless claims • Inpatient claims to Health Funds We have solutions tailor-made for: • Anaesthetists • Surgeons/Surgical Assistants • Physicians • GPs • Allied Health The software comes with up-to-date schedules for MBS/Rebate, Gap Cover (all registered health funds), Workers’ Compensation, Transport Accident authorities and DVA.
Cloud9 Software P: 1300 875 297 F: +61 2 9715 6573 E: email@example.com W: www.c9s.com At Cloud9 we understand the complexity of healthcare. We understand the importance of having the right information available when and where it’s needed. So Cloud9 created an eco-system to connect healthcare providers that supports the availability of key information to improve outcomes for the patient, clinician and organisation alike. An information infrastructure with real-time access across primary, community and acute setting benefits Clinicians trying to provide the best care for individuals as well as Researchers looking to improve safety and effectiveness of treatments. Our e-Health infrastructure has been designed to fit in with your current systems, whilst Cloud9’s next generation administrative and clinical applications allow you to upgrade existing systems as your business grows. Cloud9 Solutions: • Cloud9 Spine, Health Information Exchange • Synchronicity, Application Integration Suite. • Clarity for GP’s and Specialists. • Clarity Hospital Information System.
Digital Medical Systems P: 1300 865 977 F: +61 3 9753 3049 E: firstname.lastname@example.org W: www.dgs.com.au EASIER MEDICAL IT is a technology partnership with DMS – we make IT work for you. DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of all Australian leading medical software applications. DMS is a Business Partner for IBM, LENOVO, HP, CISCO and Microsoft. Other leading ICT brands include Webroot Secure Anywhere, StorageCraft, CA, Toshiba, Canon, Epson, Kyocera, Fujitsu and Brother. Accreditation is easier with the customised DMS IT Systems Policy and Procedures Documentation. This ensures your practice has the best IT policy, security and maintenance program that meets and exceeds the standards guidelines from the RACGP.
Direct CONTROL is the innovative answer to administrative excellence integrating with Microsoft Office, accounting applications, the OOP, clinical applications and Medicare Online. Included are all fee schedules (Medicare, DVA, Work Cover, TAC, CTP, Private Health Insurance) with built in rules relevant to each medical discipline (Allied Health, General Practice, Surgeons, Physicians including Oncology, Anaesthetists, Pathologists, Radiologists, Day Surgeries/Hospitals). Manage Episodes of Care including State, Federal and Health Fund Statistical Reporting for Day Surgeries/ Hospitals. Restructuring work flow with Direct CONTROL guarantees to provide remarkable results, enabling you to grow your business and increase cash flow.
World leading DTech provides 24x7 near Real-Time Monitoring and Management technologies sends alerts and enables our engineers to quickly troubleshoot and remotely solve problems fast of security, network, Internet, server and software on almost any client computer system or device – most are fixed in minutes… Proactive, Flexible, Consistent, Reliable, Audited, and Affordable - for the smallest to the largest practice. Call DMS for: • Systems Analysis, Solutions Design & Consulting • IT Systems Documentation for Accreditation & Compliance • Procurement & supply of leading brand hardware, software, network and peripheral products • Full Installation & Configuration services • On-Site and Remote Technical IT Support • 24x7 IT support Help Desk with extensive medical software expertise • 24x7 DTech Monitoring, Maintenance & Management • Disaster Recovery solutions • Fully managed Online Backup customised for clinical data • Fully managed Internet and Web Security EASIER MEDICAL IT – Call 1300 865 977
P: 1300 557 550 / +61 7 5478 5510 F: +61 7 5478 5520 E: email@example.com W: www.directcontrol.com.au
Doctors Control Panel E: www.pracsoftutilities.com W: PSU_admin@pracsoftutilities.com • Download and trial DCP software for GP’s and health teams. • DCP is your digital PA and guidelines advisor. • DCP facilitates TCA, GPMP and MHCP creation and tracking. • Contains guidelines licenced from RACGP. • Low annual subscription. • The best preventive care add-on software in Australia. • Compatible with MD3 and BP. • Achieve new heights in preventive care performance. • Significant benefit for patients. • Increase your revenues. • Streamline your workflow. • 3000 current users. • Several research projects based on DCP. • Try it today.
Emerging Systems P: +61 2 8853 4700 E: firstname.lastname@example.org W: www.emerging.com.au/ehealth Emerging Systems is a market leader of healthcare information and integration technology solutions. Our eHealth products and services have supported clinicians in leading Australian public and private hospitals for over a decade to deliver safe, quality healthcare. The award-winning EHS Clinical Information System is a modular, patient-centric system providing a wide range of clinical functionality to track, record and monitor patient care from pre-admission to discharge creating a multi-disciplinary EMR - improving clinical communication and patient flow while reducing patient risk. PCEHR Compliant. EHS Clinical Mobility Solution further enhances multi-disciplinary clinical communication. Emerging Systems provide clients with a full range of tailored IT services including Consultation and Managed IT Services.
Extensia P: +61 7 3292 0222 F: +61 7 3292 0221 E: email@example.com W: www.extensia.com.au Extensia links healthcare providers, consumers and their communities for better and more efficient health care. The products used to do this can be custom branded for all Organisations and include: • RecordPoint – a proven Shared Electronic Health Record that links all clinical systems, hospital settings, care plan tools and any other sources of information available. It provides a secure means of sharing critical patient data in a privacy compliant and logical structure. • EPRX – an Electronic Patient Referral Exchange and Directory. It streamlines the process of selecting a provider and completing a referral. Patient information is transferred seamlessly from clinical software. The most relevant providers, services and products are presented instantly and referral documents are generated and sent electronically.
GPA P: 1800 188 088 F: 1800 644 807 E: firstname.lastname@example.org W: www.gpa.net.au GPA ACCREDITATION plus (GPA) is the only independent accreditation program for general practice in Australia. Established in 1998 and run by a team of committed general practitioners, business leaders and experienced administrators, GPA has developed a program that continuously evolves in order to set new standards in general practice accreditation, while offering full support to practices to make accreditation both achievable and rewarding.
P: +61 2 8985 6688 / 1300 799 904 E: email@example.com W: www.episoft.com.au
GPA is committed to providing an accreditation program, which is flexible and understands the needs of busy GPs and practice support staff. Whilst accreditation gives practices access to the Practice Incentive Program (PIP), GPA believes it should offer benefits that go well beyond the PIP. Our program provides practices with a pathway to enhanced patient care, continuous professional satisfaction, improved practice efficiency and superior risk management. GPA ACCREDITATION plus certificates and signage remind patients that their practice has achieved a level of care and service above and beyond essential general practice standards.
EpiSoft’s web based platforms deliver dual purpose systems that work as comprehensive clinical and practice management platforms together with clinical trials software facilitating multi-centre investigator initiated trials. EpiSoft has developed platforms for: • Mental Health • Cancer management & surveillance • Inflammatory Bowel Disease • Hepatitis • Indigenous chronic disease management • Asthma shared care • Specialised surgery • Pre-admissions patient portal
GPA provides a system designed to accommodate busy general practices. Among our services, we offer practices the opportunity to use technologicallyadvanced, environmentally-friendly online programs, allowing staff to upload documentation at their own pace; individually assigned client managers, supporting practices through accreditation from start to success and beyond; highly-trained and sensitive surveyors, with extensive experience in all facets of general practice; and interactive training seminars, bringing practices the latest information in standards and innovation.
Affordable and scalable, EpiSoft is used in health organisations ranging from small clinics to large hospital groups across Australia, New Zealand and Singapore. Create multidisciplinary teams, collaborate effortlessly and streamline workflows with our intuitive cloud software. With the highest level of security, redundancy and reliability your data will be accessible anytime and anywhere.
Genie Solutions P: +61 7 3870 4085 F: +61 7 3870 4462 E: firstname.lastname@example.org W: www.geniesolutions.com.au Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs. Genie runs on both Windows and Mac OS X, or a combination of both. With over 2800 sites, it is now the number one choice of Australian specialists.
At GPA, we believe that accreditation should be an accomplishment, not a test, and we uphold that belief in our approach and service. For an accreditation program that will offer you assistance, support, information and satisfaction…the choice is yours.
Health Communication Network P: +61 2 9906 6633 F: +61 2 9906 8910 E: email@example.com W: www.hcn.com.au Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia’s major hospitals with online Knowledge resources. HCN focuses on improving patient outcomes by providing evidence based software tools to health care professionals at the point of care. Market snapshot: • 17,000 medical professionals use Medical Director • 3,600 GP Practices use PracSoft • 800 Specialist Practices use Blue Chip and • 2,100 Specialists use Medical Director • Leading suppliers of Knowledge Resources to Australia’s major hospitals
Health Informatics New Zealand E: firstname.lastname@example.org W: www.hinz.org.nz Health Informatics New Zealand (HINZ) is a national, not-forprofit organisation with a focus on collaboration, education and advocacy for the use of IT in the health sector. HINZ enables professional collaboration through conferences, seminars and an interactive online portal, bringing together clinicians, administrators, allied health professionals and many others with an interest in health IT and the advances it can enable. HINZ provides a platform to share information about the Health Informatics industry - leveraging best practice from New Zealand and overseas, as well as facilitating networking activities to bring industry experts and interested parties together to collaborate. Membership is for anyone with an interest in Health Informatics.
Health Informatics Society of Australia P: +61 3 9326 3311 F: +61 3 8610 0006 E: email@example.com W: www.hisa.org.au HISA is Australia’s health informatics organisation. We have been supporting and representing Australia’s health informatics and e-health community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for e-health, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics HISA members are part of a national network of people and organisations building a healthcare future enabled by e-health. Join the growing community who are committed to, and passionate about, health reform enabled by e-health.
HealthLink P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: firstname.lastname@example.org W: www.healthlink.net Transforming healthcare by connecting healthcare providers. Australia and New Zealand’s most effective secure communications service. • NEHTA compliant Secure Messaging Delivery (SMD) services • Fully integrated with leading GP and Specialist clinical systems • Referrals, Reports, Forms, Discharge Summaries, Specialists, Diagnostic Orders and Reporting • Affords all healthcare providers efficiencies in reducing paper based handling • Expert partnerships with Healthcare organisations, State and National Health Services • HL Connect for Allied Health, Telehealth and Aged Care Providers • Working with Medicare Locals Australia-wide for eHealth delivery Join HealthLink and connect with more than 85 % of Australian GPs and 99% of NZ GPs who are already part of the HealthLink community.
InterSystems P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com InterSystems is a global leader in software for connected care, with headquarters in Cambridge, Massachusetts, and offices in 25 countries. InterSystems TrakCare® is an Internet-based unified healthcare information system that rapidly delivers the benefits of an electronic patient record. InterSystems HealthShare® is a strategic platform for healthcare informatics, enabling information exchange and active analytics across a hospital network, community, region or nation. InterSystems CACHÉ® is the world’s most widely used database system in clinical applications. InterSystems Ensemble® is a platform for rapid integration and the development of connectable applications. InterSystems’ products are used by thousands of hospitals and laboratories worldwide, including all of the top 15 hospitals on the Honor Roll of America’s Best Hospitals as rated by U.S. News and World Report. For more information, visit InterSystems.com
MEDITECH Australia P: +61 2 9901 6400 F: +61 2 9439 6331 E: email@example.com W: www.meditech.com.au A Worldwide Leader in Health Care Information Systems MEDITECH today stands at the forefront of the health care information systems industry. Our products serve well over 2,300 health care organisations around the world. Large health care enterprises, multi‑hospital alliances, teaching hospitals, community hospitals, rehabilitation and psychiatric chains, long-term care organisations, physicians’ offices, and home care and hospice agencies all use our Health Care Information System to bring integrated care to the populations they serve. Our experience, along with our financial and product stability, assures our customers of a long-term information systems partner to help them achieve their goals.
Medtech Global Ltd P: 1800 148 165 E: firstname.lastname@example.org W: www.medtechglobal.com
For over 30 years, Medtech Global has been a leading provider of health management solutions to the healthcare industry enabling the comprehensive management of patient information throughout all aspects of the healthcare environment.
P: 1800 420 066 (AU) P: 0800 401 111 (NZ) E: email@example.com W: www.houstonmedical.net
Health Information Management Association of Australia P: +61 2 9887 5001 F: +61 2 9887 5895 E: firstname.lastname@example.org W: www.himaa2.org.au The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia. HIMAA aims to support and promote the profession of health information management. HIMAA is also a Registered Training Organisation conducting, by distance education, “industry standard” training courses in Medical Terminology and ICD-10-AM, ACHI and ACS clinical coding.
“We provide time to health professionals through efficient practice management software” Our multidiscipline software provides interfaces to every major manufacturer, enabling many clinics to save space by becoming completely paperless! We are a progressive medical software company and take pride in working with our health care clients to deliver tailored EMR and PMS packages based on each unique situation and practice requirements. We’re focused on helping to make their businesses more efficient and productive as well as delivering measurable improvements in customer satisfaction and market share. You can arrange a free demonstration of our software by visiting: www.HoustonMedical.net
Leecare Solutions P: +61 3 9339 6888 F: +61 3 9339 6899 E: email@example.com W: www.leecare.com.au Leecare Solutions, with their products Platinum 5 & P5 Exec, are the aged care industry’s leading web browser based clinical and management software system. Since 2000, Leecare has provided relevant, contemporary software solutions for Australian and New Zealand aged care organisations. Leecare’s mission and products provide outstanding clinical decision making support, and management support tools that use any device, can be installed on multiple platform types and in any location. Used in over 30,000 aged care places, it is the solution used by quality providers, proven through thousands of accreditation, validation and other regulatory visits, as it is based on professional clinical and lifestyle provision concepts.
Medtech’s Medtech32 and Evolution solutions improve practice management and ensure best practice for electronic health records management and reporting. Clinical Audit Tool integrates with Medtech32 and Evolution providing fast, efficient and secure analysis of patient data enabling practices to identify and deliver services, which address health care priorities across their population. Medtech’s ManageMyHealth patient and clinical portal enables individuals to access their health information online and engage with their healthcare provider to support healthy lifestyle changes.
MIMS Australia P: +61 2 9902 7700 F: +61 2 9902 7701 E: firstname.lastname@example.org W: www.mims.com.au MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust. MIMS information is backed by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages. Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base. MIMS is delivered all the ways you need – print to electronic, on the move, to your patient’s bedside or your consulting room desk. Whatever the format, MIMS has the latest information you need.
Orion Health P: +61 2 8096 0000 / +64 9 638 0600 E: email@example.com W: www.orionhealth.com Orion Health is New Zealand’s largest privately owned software exporter and a global leader in eHealth technology. Founded in 1993, by CEO Ian McCrae, Orion Health has grown from a specialist health integration vendor into a company that sells a comprehensive suite of eHealth solutions. Orion Health has extensive experience in the design and installation of complex systems within demanding healthcare environments. Orion Health designers and engineers work right alongside in-house clinicians in order to develop elegant and intuitive products that encourage swift adoption with minimal disruption, allowing your clinicians to focus on patients. Today, our products and solutions are currently implemented in more than 30 countries, used by hundreds of thousands of clinicians, and help facilitate the care for tens of millions of patients.
OzeScribe P: 1300 727 423 F: 1300 300 174 E: firstname.lastname@example.org W: www.ozescribe.com.au
MITS:Health P: 1300 700 300 E: email@example.com W: www.mitshealth.com.au Managed IT Services for the Health Industry MITS:Health provides a full range of IT services specifically tailored for medical centres, GPs and specialists across Melbourne. • • • • • •
Equipment supply and installation Remote monitoring and support Data backups Networking Internet Website Development
OzeScribe is the dictation and transcription solution for most Australian university teaching hospitals and major private clinics. It really does make sound business sense to let OzeScribe worry about managing dictation, transcription and technology. We provide free electronic document delivery – OzePost – to your EMR and your associates’ EMR, saving you thousands of dollars in time, packing and postage. OzeScribe is the provider of the most advanced solutions available. • Run by doctors – for doctors. • Australian trained typists. • Manage dictation and transcription via computers, iPhone, iPad, android or smartphones. • Integrated M*Modal speech recognition technology on demand.
PicSafe Medi P: +61 3 9670 9339 E: firstname.lastname@example.org W: www.picsafe.com The Secure Mobile Medical Imaging System Designed by Australian and US Dermatologists and Plastic Surgeons to be used by a wide range of healthcare professionals working in a variety of clinical settings, PicSafe Medi (patent pending) is as simple as using the normal camera function on your mobile smart device except... your patient’s photo is completely secure and legally compliant in its consent, transmission, and storage when taken with PicSafe... Both iOS and Android compatible, PicSafe Medi simultaneously suffices patient privacy and related government regulatory requirements (including new Federal APP’s, commencing 12th March, 2014) surrounding the capture, use, and storage of medical photographs. Using PicSafe Medi, Healthcare professionals can now quickly connect and efficiently document a patient’s status pictorially, facilitating the medical referral process and, ultimately, improving patient outcomes and satisfaction. Stored clinical photographs are fully patient-consented (including authorisation for specific usages of their photo), watermarked to assure authenticity, and managed in a highly secure, auditable, private server environment, accessible only to authenticated PicSafe users. From the time you take a patient’s photo with a smart device, to the encrypted transmission and secure storage phases of photo handling, the process is seamless and non-intrusive to both photographer and patient. • Increase your efficiency and improve your patients’ clinical outcomes • Remove the worry surrounding costly patient privacy breaches • Assure quick, efficient pictorial documentation of your patient’s status • Facilitate a streamlined medical referral process • Fully document your patient encounters for billing, auditing, and medical-legal purposes PicSafe-Medi is “the missing link” in compliant mobile clinical photography.
Precision IT P: 1300 964 404 F: +61 2 8078 0257 E: email@example.com W: www.precisionit.com.au • Cloud Computing Specialists. • Onsite Medical IT Support. • VoIP Telephone Systems and Internet Connectivity. • IT Equipment Procurement. • Experience with all clinical & practice management software packages. • Sydney, Brisbane, Gold Coast and Melbourne. Precision IT is a highly competent and impeccably professional IT support firm with a primary focus on working with GPs and Specialists. Working with our clients, we develop reliable, robust and feature rich IT systems to meet the demands of the modern medical practice today and into the future. Our Precision Cloud service is fast becoming the choice for new and established practices and covers all of the standard guidelines from the RACGP and AGPAL and GPA. Talk with us today about the future of your practice!
Professional Transcription Solutions P: 1300 768 476 E: firstname.lastname@example.org W: www.etranscriptions.com.au Australia’s Most Trusted Teaching Hospital and Private Practice Transcription Provider • Web-based - Dictate and receive reports anywhere • Double-edited with over 99.5% accuracy • Fast turn-around within 24 - 48 hours, as required • All medical and surgical specialities covered in Australia’s largest teaching hospitals • Rapid documentation of recorded HR interviews, Research and Expert Reports • Guaranteed cost savings • Data held securely at a State Government owned data centre • Call our friendly staff anytime for your overflow, backlog or all of your typing or data entry requirements • Call us now for a no obligation free trial
Shexie Medical System P: 1300 743 943 F: 1300 792 943 E: email@example.com W: www.shexie.com.au Shexie is an Australian owned business which has been developing software for medical practices for over 15 years. Our industry and technical knowledge allows us to provide the ultimate ‘easy to use’, ‘fully functioned’ and ‘robust’ product on the market. Shexie Medical System clinical and practice management software is ideal for surgical or specialist practices of any size. Many fully integrated features including Paperless Office, SMS, full Paperless Electronic Claiming including Eclipse, MIMS Integrated, statistical analysis, security, synchronize appointments with Outlook/PDAs, transcription interface, diagnostic equipment interface, automated MBS/Fund rates updates. Soon to be released Shexie Platinum version also contains eHealth - Health Identifiers, PCEHR and Secure Messaging.
Sysmex P: +61 3 9013 4445 E: firstname.lastname@example.org W: www.sysmex.com.au Sysmex is dedicated solely to helping your healthcare organisation achieve more in less time, with fewer errors and better patient outcomes. Sysmex leads the way in eDiagnostics: • Providing an essential building block for the electronic medical record with the Eclair Clinical Information System • Enabling sharing of key patient information across regions through the Eclair Clinical Data Repository • Completing the electronic loop with laboratory and radiology order request management (CPOE) • Streamlining all areas of the anatomical pathology laboratory workflow from request to report with Delphic AP • Improving reporting times and reducing costs through an enterprise Delphic LIS, shared across multiple laboratories
Totalcare Stat Health Systems (Aust) P: +61 7 3121 6550 F: +61 7 3398 5064 E: email@example.com W: www.stathealth.com.au Stat Health Systems (Aust) has built a progressive and resilient system that introduces a new level of stability and flexibility to the medical software market. Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution. Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. Stat incorporates all eHealth requirements as per the NEHTA specification. Stat Health provide a premium support service, clinical data conversion from existing software and tailor made installation and training plans for your practice. Facebook: facebook.com/StatHealth Twitter: @NotifyStat
P: +61 7 3252 2425 F: +61 7 3252 2410 E: firstname.lastname@example.org W: www.totalcare.net.au Totalcare is a fully integrated Clinical, Office and Management software suite designed to suit the particular needs and processes of healthcare providers. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals, Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a multisite, multi-disciplinary corporate entity or hospital, Totalcare can provide solutions for your needs. • • • • • • • •
Admissions / Appointments Billing Statutory Reporting Integrated SMS Prescriptions Orders & Reports Clinical Notes Letter/Report Writing, Document and Image Management • Scanning and Barcode recognition • Video and Image Capture • HL7 Interfaces
Therapeutic Guidelines Ltd P: 1800 061 260 E: email@example.com W: www.tg.org.au Therapeutic Guidelines Limited is an independent not-for-profit organisation dedicated to deriving guidelines for therapy from the latest world literature, interpreted and distilled by Australia’s most eminent and respected experts. These experts, with many years of clinical experience, work with skilled medical editors to sift and sort through research data, systematic reviews, local protocols and other sources of information, to ensure that the clear and practical recommendations developed are based on the best available evidence. eTG complete Incorporates all topics from the Therapeutic Guidelines series in a searchable electronic product, and is the ultimate resource for the essence of current available evidence. It provides access to over 3000 clinical topics, relevant PBS, pregnancy and breastfeeding information, key references, and other independent information such as Australian Prescriber (including Medicines Safety Update), NPS Radar, NPS News and Cochrane Reviews. eTG complete is available in a range of convenient formats – online access, online download, CD, and intranet access for hospitals. Multi-user licences, ideal for a practice or clinic, are also available. It is widely used by practitioners and pharmacists in community and hospital settings in all Australian states and territories. The March 2014 release of eTG complete includes updates of further Endocrinology topics, including disorders of bone and calcium homeostasis, and adrenal disorders. miniTG The mobile version of eTG complete is miniTG, (in offline format), offering the convenience of vital information at the point of care for health professionals who practise and consult on the move. It is supported on a wide range of mobile devices, including Apple®, Pocket PC®, and selected Blackberry® devices.
VIRTUAL CONSULTING ROOMS
VConsult P: 1300 82 66 78 F: 1300 66 10 66 E: firstname.lastname@example.org W: www.vconsult.com.au VConsult offers outsourced practice management solutions for medical and allied health practitioners allowing the focus to be on your professional practice and patient care. VConsult provides a seamless “behind the scenes” service by professionally managing your telephone calls, reception, invoicing and medical transcription requirements. VConsult is perfect for your practice if you are: • Setting up, already established or winding down in Private Practice • Working in a public appointment and want to portray a professional image • Looking to minimise your overhead costs • Requiring your patient calls to be answered by a professional and experienced medical receptionist.
Zedmed P: 1300 933 000 F: +61 3 9284 3399 E: email@example.com W: www.zedmed.com.au Zedmed is an innovative provider of business solutions to the medical and financial services industries. Our practice and clinical management solution is designed to be simple, intuitive and seamlessly integrated. With personalised training, installation and data conversions from almost all software packages, changing software has never been so easy. Zedmed would also like to introduce to you Medical Record Exchange – a free, simple solution allowing Doctors to send patient’s medical information to insurance companies electronically. Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis. For more information about Medical Record Exchange, please contact us: Phone: 1300 933 833 www.medicalrecordexchange.com.au
Home visits and after hours care 18 Feb Practice information
Reminders, recalls and results
Management of health problems 13 Mar Continuity of care