Australasiaâ€™s First and Only eHealth and Health IT Magazine
19 MAY 2014
AGED CARE ICT & E-HEALTH Aged and acute
Developing a transfer document for the PCEHR could improve information sharing with hospitals.
A single medication profile is essential in a resident-centred IT model for residential aged care.
The digital GP GPs should take a strategic view of their IT requirements when visiting patients in residential care.
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 the remainder of 2014 now available. To register your interest and obtain a media kit, email: email@example.com
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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 four editions for 2014 to be distributed for release in: • July 2014 - Hospitals • Mid-August 2014 - Practices • October 2014 - New Zealand • Mid-November 2014 - mHealth and devices
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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 Jeff Carson, Dr Karen Day, Bryn Evans, Chris Gray, Simon James, Dr Henry Konopnicki, Dr Caroline Lee, Damien Malone, Kate McDonald, Christine Veal and Peter Young. 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.
MEDICAL MONITORING BY REMOTE
TELEHEALTH FOR HOME AGED CARE
MOBILE NURSING WORKFORCE
ITAC EYES THE HOME
DIGITAL CARE SERVICES
THE DIGITAL DOCTOR
DRIVING THE PCEHR
PHRS AND PATIENT VOICE
THE CONNECTED NURSE
Simon James laments the ongoing lack of eHealth leadership being provided by the government.
SELECTED BITS & BYTES Consumer registrations for the PCEHR hit the 1.5 million mark Exploit vulnerabilities found in CDA documents do not affect the core of the PCEHR, an expert says
Budget constraints, a lack of resources and resistance to technology are barriers to investment in aged care ICT.
Computerised CHAT to streamline pre‑operative assessments
DocAppointments extends product suite with patient demographics and survey app
The adoption of a resident-centred IT model with a single resident profile caters for every step in the medication pathway.
Renewed calls for real-time prescription drug monitoring
CAROLINE LEE The sharing of information between aged care and acute care would be improved by the creation of a transfer document on the PCEHR.
MEDrefer integrates with Genie for specialist referrals
MSIA For telehealth to fulfil its potential in keeping older people at home longer, sustainable business models are essential.
RDNS nurses who visit elderly clients in their homes use a variety of technologies to function as a truly mobile workforce.
EVENTS Up and coming eHealth, Health, and IT events.
PULSE+IT DIRECTORY The Pulse+IT Directory profiles Australasia’s most innovative and influential eHealth and Health IT organisations.
ITAC 2014 in Hobart will look at how assistive technologies are revolutionising seniors’ living.
The ACIITC’s blueprint for harnessing aged care ICT.
GPs visiting patients in residential aged care facilities need to take a strategic approach to their ICT.
The capabilities of clinical software for clinical risk management.
Feros Care has invested in a range of technologies, including WiFi, tablets and touchscreen robots.
PCEHR still in its early stages in RACFs, awaiting the lead of GPs.
Portals, apps and PHRs help provide a holistic health history.
RDNS’s mobile platform for nurses keeps them connected on the road.
CLARITY NEEDED FOR E-HEALTH AND AGED CARE As we enter the fifth straight month in which the federal government has remained silent on its plans for the PCEHR and eHealth in general, frustration at a lack of direction is growing, no more so than in the aged care sector. For the segment of the population that stands to gain most from eHealth, a strategic outlook for ICT is required to bring aged care up to speed with the wider healthcare community.
SIMON JAMES BIT, BComm Editor: Pulse+IT email@example.com
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.
After the enormous disruption caused by the previous government’s Living Longer Living Better reforms and the introduction of consumer-directed care, the early signals from the new government are that the aged care sector will be allowed a bedding-down period before any new major reforms are introduced, beyond the move to raise the pension age.
at length about its possible content at this juncture makes little sense. However, on indulgence, the concept of a so-called GP tax (in either a $6 or $15 guise) has received such sustained interest throughout 2014 that its potential impact on the IT systems in general practices merits a brief discussion in this particular magazine.
That aged care flies under the radar – or some would say is often forgotten in the broader scheme of things – will come as no surprise, as the sector often is the last to be consulted. This is no more apparent than in the roll-out of eHealth and investment in ICT in general, and yet it is here that early investment to keep people healthier and at home for longer has the greatest potential to deliver future savings.
While the introduction of such a measure would have significant ramifications for both the business of general practice and the broader community, practices that predominantly bulk bill their patients may find themselves needing to substantially reconfigure their reception workflows to accommodate such reforms to Medicare’s foundations.
With some in the industry estimating that only around half of all residential aged care facilities regularly use an electronic clinical information system, it is no surprise that the Aged Care Industry IT Council is calling for increased investment from the government to get aged care up to speed. In straightened budgetary times, however, that may turn out to be a forlorn hope. With this edition of Pulse+IT entering production in the week before the Treasurer’s budget address, speculating
Setting aside the broader financial changes practices may have to contend with, there are many IT considerations practices should be mindful of should such payment arrangements be introduced. For example, all practice software developers would likely need to update their products, and roll these new versions out for installation by practices en masse. The configuration of the billing and Medicare claiming functions of the software would then need to be reviewed in line with the practice’s relevant policies and procedures, which themselves would
likely need to be updated to reflect the changes. Even seemingly benign systems like the practice’s EFTPOS arrangements may need to be revisited to ensure bank fee structures are appropriate to handle an increased volume of small transactions. While undertaking this process, it would be timely for practices to consider integrating their EFTPOS terminal with their billing software, if indeed this is possible and they haven’t already taken this step. A comprehensive analysis of the budget as it pertains to the health sector will be available on Pulse+IT’s website by the time this magazine reaches you, and I welcome your reactions to the budget online.
eHealth leadership vacuum For the third consecutive edition this year, this author finds himself lamenting the ongoing lack of eHealth leadership being provided by the government and the relevant departments and agencies that operate in the sector. Health Minister
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Peter Dutton has not yet publicly released the review into the PCEHR, nor made any substantive comments about its contents, nor detailed the government’s reaction to the material presented by the panel members in their report to the minister.
a range of other media outlets have been rejected on the grounds that the release of the document is not in the public interest. With the review process informed by scores of detailed submissions, and given the large sums of money the project has consumed, it remains curious that the government has not yet seen fit to at least make some detailed public statements about its plans for the PCEHR.
On receipt of the review in December 2013, Mr Dutton issued a brief statement acknowledging the submission of the report, which “looked into significant concerns about the progress and implementation of the PCEHR” and “provides a comprehensive plan for the future of electronic health records in Australia”. The statement finished with an undertaking that the “government would now take time to consider the review recommendations and would respond in due course.”
Clarity about the government’s ambitions for both the PCEHR, and eHealth more broadly, is needed at this time to inform both the medical software industry, charged with investing private resources to improve and further develop the system, and the tens of thousands of healthcare providers one assumes will ultimately be expected to interact with eHealth systems as part of their day-to-day work.
At the time of writing – a full five months on since the report was submitted to Mr Dutton – this undertaking has not been fulfilled, and numerous Freedom of Information requests filed by Pulse+IT and
For the aged care sector, which also employs large numbers of healthcare workers that would benefit from improved ICT, the lack of clarity and investment is an ongoing concern.
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MOMENTUM BUILDS FOR
INCREASED UPTAKE OF AGED CARE IT There is no doubt that increased uptake of ICT can help support the many challenges facing the aged care industry, particularly as the implementation of consumer-directed care (CDC) begins, but there are still multiple challenges facing individual providers and the sector as a whole. However, momentum is beginning to build as advancements such as SaaS, cloud computing and mobile devices help to overcome the main barriers.
CHRIS GRAY B.Bus, MBA Managing director, iCareHealth firstname.lastname@example.org
About the author Chris Gray is a founding shareholder and director of iCareHealth, and managing director of the Australian business since May 2007. He oversaw the purchase of the RxRight medication management system and the electronic integration of GP records. Prior to joining iCareHealth, he was a senior executive with Dun & Bradstreet.
Over the coming decades, demographic changes will alter the dynamics of our population and significantly increase the demand on aged care services. As our ageing population increases, and the implementation of consumer-directed care (CDC) begins, the impact of the demographic change will see a greater call for complex, personalised services that support individuals and their families to live fulfilling and independent lives in their own communities.
that improve the quality of life and care experience for residents, consumers and care workers. Despite the opportunity of these benefits, the uptake of technology across the broader aged care sector has been relatively slow.
The aged care sector already faces existing financial, compliance and workforce challenges, and when combined with this increased demand on the industry, it is more important than ever that providers utilise all means possible, including ICT, in order to meet these challenges.
Irrespective of size, many providers are already operating in a revenueconstrained environment. Not surprisingly, the availability of funding to cover the investment costs of ICT is one of the most obvious challenges.
The recently released ACIITC report, Digital Care Services, recommended that providers boost their annual ICT spend from less than two per cent to four to five per cent of gross revenue, which would provide the foundations for ICT to play a key role in helping to meet the challenges faced by the aged care industry. The potential benefits of the greater use of technology in the aged care sector range from the economic benefits of reducing the cost of service and improving overall profitability, to the non-financial benefits
Therefore, what are the most common challenges that are hindering the uptake of technology within the industry?
1. Budget constraints
Whether implementing new technology for the very first time or modernising existing technologies, the capital outlay required for infrastructure, hardware, implementation, maintenance and system upgrades can seem to be unaffordable for many organisations. Understandably, when you are used to existing structures, systems and processes â€“ even if they are inefficient â€“ taking a step back to consider the ways to make improvements can be quite difficult. However, there are substantial gains that come with identifying issues, problems and
challenges, then restructuring activities and investing in the right technology solutions to work through these. When exploring and reviewing possible technology-based solutions, it is important to delve deeply into the specific benefits and understand how these can help your own organisation to improve efficiency, productivity, quality of care – areas that can all have a positive impact on the bottom line. A clear, accurate view of the benefits – from a strategic and operational level, right through to the advantages for staff on the floor – can help showcase the inherent value of technology, making it easier to plan and obtain the necessary budgetary support from the top level. Advancements such as Software as a Service (SaaS) and cloud computing are driving down the costs of aged carespecific applications, making these solutions increasingly more affordable.
2. Lack of internal resources Another common obstacle can be the perceived lack of internal resources available to support the introduction of new technology. Larger aged care organisations may have the workforce structures in place with dedicated IT managers and support staff to oversee the implementation of new technology, in addition to ongoing support and management of an IT system. However, the availability of similar resources are beyond the capabilities of many small to medium organisations. Where the internal resources required for IT management and support are simply not available, considerable pressure may be placed on staff who lack the expertise and qualifications to deal with these issues. It’s important that your chosen software provider can offer you an adequate level of ongoing, personalised support to ensure that staff are not spending their valuable time having to manage the new structures
“Despite the opportunity of these benefits, the uptake of technology across the broader aged care sector has been relatively slow.” Chris Gray
and systems. Ideally, you should be offered access to a support team 24 hours a day, seven days a week so they are available when problems occur. Prospective technology providers should also offer multiple support channels.
According to Frost & Sullivan’s latest report, Australian Mobile Device Usage Trends 2013, mobile devices have transitioned to more sophisticated multi‑functional usage based on their mobile media capabilities.
When you’ve made a commitment to invest in technology, another effective way to encourage the uptake internally is to utilise your biggest influencers, or ‘IT champions’. An internal IT champion can act as the key point person to manage the project and act as the go-to resource between senior management and staff. They can also assist in lowering training costs and relieve support and troubleshooting requests, as they willingly impart their knowledge.
It is estimated that Australia’s smartphone penetration in 2013 was at 73 per cent in the 15 to 65 age group, and predicted this to reach 93 per cent by 2018, when it is likely that virtually all mobile phones will have built-in smartphone functionality.
3. Resistance to technology Another factor preventing aged care providers from making better use of technology is resistance from staff. There is a common opinion that care workers do not possess a high level of IT skills and capabilities, and therefore can be resistant when it comes to new technology. As in any sector, the level of IT skills and capabilities vary considerably in aged care. With time, even those staff with minimal experience will become increasingly computer literate and come to expect the same technology standards experienced elsewhere in their lives.
Penetration of tablet devices in Australian households is also forecast to increase significantly from 49 per cent in 2013 to 80 per cent in 2018, ultimately outpacing the growth of smartphones. Technological change is accelerating at an exponential rate. As technology continues to revolutionise every facet of our lives, the level of confidence that care staff feel towards working with technology will continue to increase. Despite these challenges, there is an increasing momentum towards technological uptake in the aged care sector. As the workforce shrinks, becomes more disparate and consumers desire greater connectivity to the community, technology will be critical in improving operating efficiencies and consumer experience.
IT AND THE MEDICATION USE PATHWAY Medication misadventure and miscommunication is one of the most serious issues in healthcare, and it has particular ramifications for the elderly. In residential aged care, the adoption of a resident-centred IT model, with a single resident profile, ensures that every step in the medication pathway is catered for, including the prescription, the documentation, the dispensing and the administering of medications.
CHRISTINE VEAL BSc (Hons) Pharm AACPA Professional services pharmacist Webstercare
Medication misadventure is more common in the elderly and is associated with poor health outcomes. In Australia, medication misadventure is estimated to be responsible for 15 per cent of all hospital admission, 35 per cent of unplanned hospital readmissions and to cost the Department of Health $660 million a year.1 A known contributor to medication misadventure is the failure to communicate essential information. The aged care resident is particularly vulnerable to potential drug interactions, missing allergy information, miscommunication of the correct dose, or inadequate monitoring. To provide strength to an organisation’s clinical governance, IT solutions need to be secure, robust, be able to communicate and monitor medication safety and quality.
About the author Christine Veal is a professional services pharmacist with medication management specialist Webstercare, which developed the widely used Webster-pak. Webstercare also offers the MedsPro system using the Virtual Pill Count (VPC) software that is widely used in pharmacies that supply residential aged care facilities.
Medication miscommunication is a significant problem in the aged care industry and one which may result in over-medication, duplicated medication or omission of essential medicines. The impact on an individual resident may be profound and long-lasting. For example, not adjusting a resident’s dose of warfarin in a timely manner can result in severe bleeding and hospital admission. This misadventure could be avoided by streamlining communication
with the use of a secure messaging system to communicate between all members of the resident’s care team. While this is a potential tragedy for the individual resident and their family, it also affects staff confidence in the system they follow. In an article in the Australian Journal of Advanced Nursing2 nurses expressed concern about elderly residents being ‘warfarinised’, highlighting a lack of confidence in the clinical robustness of the current processes for monitoring warfarin use in the aged care setting.
The resident’s profile For the sake of robustness and accuracy, it is essential that there is only one central medication record for each resident. Adopting a resident-centred IT model ensures every step of the medication pathway is catered for, from the GP making the decision to prescribe, to documentation on the medication charts, dispensing and packing the medicines, identifying the right medicine and accurately administering it to the resident, documenting the administration process and monitoring all systems and outcomes. A single medication profile can be developed by integrating the medication order provided by the doctor, the administration history provided by the
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“As a professional services pharmacist, I frequently take phone calls from rural aged care facilities who only have limited access to GPs, and where a one‑day‑a‑week GP visit is viewed as a luxury.” Christine Veal
nursing staff, together with the pharmacy medication profile. The fundamental principle is that every step is designed to facilitate the “7 rights of medication management” in a clear and intuitive way: person, medication, dose, time, route, documentation, outcome. The single central medication profile is an important tool for a residential aged care facility when considering medication misadventure vulnerabilities. The single, central profile ensures information is consistent across all components used for medication management. This provides confidence to an organisation that a resident’s medication information is current, consistent and accurate. Admission to an aged care facility or being transferred between care settings increases the risk of medication errors. More than 40 per cent of medication errors in hospitals are believed to result from inadequate medication information on admission, transfer and discharge.3 The steps in collating a medication profile are straightforward. For a newly admitted resident the steps include obtaining and verifying a patient’s medication history documentation and writing a medication chart. Also important is to ensure a clear colour photo of every resident is taken
on admission, which allows nurses to confirm identity during the medication administration process. These are the simple steps. The challenge, however, comes in the gathering, organising and communication of medication information across the aged care team where not all members of the healthcare team are on the premises or always easily accessible. Managing medication changes is not straightforward. As a professional services pharmacist, I frequently take phone calls from rural aged care facilities who only have limited access to GPs, and where a one-day-aweek GP visit is viewed as a luxury.
Multiple medications How does an organisation ensure appropriate clinical governance in a constantly fluctuating environment with multiple medication changes that also require constant faxing of medication charts? After frequent faxing charts become illegible, missing vital resident information, facility section information, and the now black and white photos become irrelevant. More importantly though multiple faxed charts mean there are increased risks to the resident due to multiple versions of medicine on the medication chart.
This is a constant source of frustration among pharmacists, aged care staff and GPs. Faxes are insecure methods of communication, plain and simple. I have even heard of medication charts containing private and personal medical information having been faxed to the local newsagent because a staff member used the incorrect auto-dial function on the fax machine. New privacy legislation makes this an even greater risk to the facility and the patient’s healthcare provider. Secure electronic communication and a single electronic health record for each patient is generally believed to contain more accurate information with easy retrieval. They also provide date and timestamped tracking of medication orders and communication. However, it is important to remember any system is only as good as the framework, processes and governance that support it. In addition to designing and implementing an IT system, an organisation should also consider defining all processes, allocating responsibility, identifying expected time frames, training key staff and evaluating all these process.
Medication administration The non-signing of medicines is an ongoing issue in aged care. If the administration of a medicine to a resident is not accounted for, it is difficult for supervising staff to determine whether the medication was not administered due to oversight, or withheld for a reason, or whether it was administered but simply not signed for. There are many reasons a medication may be omitted: stress, high workload, fatigue, poor lighting and noise are all identified as contributing factors. A Victorian study found that interruptions and distractions contributed to 25 per cent of administration errors.4
Auditing is problematical in paper-based systems which are usually difficult to monitor and maintain. Often, timeconsuming audits are not completed due to a lack of available resources. Electronic medication management systems, with the capability to retrieve historical data, allow for clinical and administration reports to be quickly generated to facilitate auditing, data trending, benchmarking, staff resourcing and performance monitoring.
Management analysis and support Data generated by electronic medication management systems can be used to feed into quality improvement systems. For example, alerts about the use of antipsychotic medicines in people with dementia have been increasingly highlighted in the media, yet there have been minimal advancements within the aged care industry. NPS MedicineWise recently collaborated with Webstercare to produce a Quality Use
of Medicine report on antipsychotics for behavioural and psychological symptoms of dementia. Data is extracted directly out of each resident’s historical records that are stored within the pharmacy’s medication management software.
compliance with legislation, professional guidelines and contemporary practice. IT can also provide efficiencies by streamlining processes, reduce risk and, most importantly, improve medication outcomes for residents.
Directly accessing each individual resident’s electronically stored data eliminates a number of errors associated with auditor bias, comprehension and drug knowledge. The objective approach supports clinical governance as missing information or unusual trends in use are identified more efficiently, and corrective action or strategies can be implemented to support positive outcomes.
When travelling down the medication management pathway an organisation should take a systematic approach to maximise the potential that advances in IT have to offer. A complete medication management system can optimise overall clinical safety and provide support to an organisation’s
1. Semple S, Roughhead E. Medication safety in acute care in Australia: where are we now? Part 1. A review of the extent and causes of medication problems. Australia and New Zealand Health Policy; 6(1); 2002–2008 2. Bajorek B, et al. Warfarin use in the elderly: the nurses’ perspective. The Australian Journal of Advanced Nursing 2006; Vol.23: 19-25 3. Barnsteiner J. Patient Safety and Quality: An Evidence-Based Handbook for Nurses; 2008: Chapter 38. 4. Lederman RM, Parkes C. Systems failure in hospitals – using Reason’s model to predict problems in a prescribing information system. J Med Syst 2005; 29: 33-43
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AGED CARE AND THE HOSPITAL INTERFACE While much of the emphasis in the development of national eHealth initiatives such as the PCEHR has been on the primary care sector, it is in aged care – and aged care’s relationship with acute care – that the information sharing promised by eHealth is most sorely needed. Progress has been made, with some acute and aged care facilities able to access each other’s information, but there is still some way to travel.
DR CAROLINE LEE RN, PhD CEO, Leecare Solutions email@example.com
During 2012 and 2013, with the financial assistance of NEHTA and the Department of Health, four aged care software companies worked to develop substantial software components necessary to enable aged care providers to access the PCEHR for their residents or clients through their software, and to register residents to the PCEHR. This project was aimed at ensuring that information communicated between health organisations and professionals was supported in a secure, structured, and useful method. There is some way to go until full adoption is achieved across the sector, and the industry is still awaiting the release of the Pathfinder project’s PCEHR aged care information sheets to guide providers through the process. The industry will support this process, once they are supported to use it, as aged care staff and providers know the benefits of having access to a resident’s health history.
About the author Dr Caroline Lee is founder and CEO of Leecare Solutions and immediate past president of the Aged Care IT Vendors Association (ACIVA). She has a Masters of Health Science in gerontology and her PhD focused on gerontological nurse practitioners.
These benefits include access to the information prior to admission to acute care to plan care and resources, when sending a resident to hospital so residents receive relevant care in their new environment, and following discharge from hospital to ensure appropriate changes to care are made.
Whilst the aged care industry awaits the release of PCEHR access suport, it has not ceased working out methods to share information with hospitals. Providers have continued to ensure that information sharing is robust to avoid negative consequences for residents or clients by developing documents such as discharge templates to be used within regions and establishing key criteria to be shared.
Demographic changes Improving the interaction between aged care and acute care is essential when considering the demographic factors we are currently facing, which will only increase in the future. For example, in 2011-12, there were approximately 9.3 million episodes of admitted patient care in Australian hospitals, with public hospitals accounting for 60 per cent of these (5.5 million). Half of these were same-day admissions. People aged 65 and over accounted for 39 per cent of all admissions and 48 per cent of patient days. For persons aged 85 and over, there was an overall increase of 40 per cent in admissions between 2007-08 and 2011-12, an average increase of nine per cent each year. At 30 June 2012, there were 252,890 operational aged care places, with three
in four government-subsidised aged care places in residential aged care and the remainder in community care. The typical age of clients in community care packages was 83, about three years younger than clients in permanent residential aged care. According to the Australian Institute of Health and Welfare, nearly one in two people in permanent residential aged care required high-level care to manage behaviour, and over 50 per cent of permanent residents in federally subsidised aged care facilities had a diagnosis of dementia. Many cannot reliably discuss their healthcare needs or issues with acute care staff when admitted.
Robust information An admission to hospital from an aged care facility is often just for one event or clinical issue, but the multiple disease presentation an aged person often brings means acute care staff need to understand all care interventions required by that person. This is especially so if they have dementia or behaviour issues which prevent them from articulating their needs themselves. And it is not just the interventions relevant to their presentation that are important. Older people admitted to hospital require a full care plan to be delivered with full medication history details so that acute care staff can accurately plan for continued care for all of the clinical needs the individual has, not just the presenting need. As noted, some parts of Australia have begun developing admission and discharge documents that could ultimately provide a template for the PCEHR. The sort of information contained in these templates can vary, but in essence, an admission document from aged care to acute care needs to state:
“Whilst the aged care industry awaits the release of PCEHR access support, it has not ceased working out methods to share information with hospitals.” Dr Caroline Lee
• Demographics such as name, date of birth, nursing home name, next of kin, religion • A summary of the reason being sent to hospital • Current medical diagnoses and past history • What has occurred over the past three days (progress note entries) • The last set of observations taken of the person • Dietary and fluid management needs – eating ability • Level of mobility and skin management • Comprehension/communication strategies • Continence management strategies and assistance required re toileting • Medication regimen the person is currently on • Behaviour management strategies • Assistance required with hygiene • Presence of Living Will or palliative care wishes. From discharge from hospital back to aged care it requires: • Final diagnosis of event/cause of admission • Summary of treatment undertaken whilst admitted • Any changes to the medication regimen required or to be followed • Actual tests and results undertaken whilst in hospital.
Software requirements To provide better, more individualised care for older people, both aged care and acute care organisations need modern and robust clinical software systems to share their information. They need systems they can afford, that take away inefficient information-sharing practices, that share evidence-based clinical information and that reduce an organisation’s total cost of ownership so that redundant activities and money can be channelled into effective outcomegenerating activities. In addition to the full documentation and reporting requirements that aged care providers currently have to maintain and store, in the future providers will also need to ensure their software is capable of interfacing directly with the PCEHR to facilitate information sharing amongst hospitals and other health professionals, including GPs, pharmacists and allied health providers. Using IT effectively will allow staff to spend less time on administrative tasks and more time on residents, clients and their families, ensuring acute episodes are managed efficiently. These improvements can only benefit management and staff alike.
Consumer registrations for the PCEHR hit the 1.5 million mark The latest figures from the Department of Health show that consumer registrations for the PCEHR have topped 1,500,000, exceeding the department’s target for the system by a number of months.
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After a slow start in which the forecast of 500,000 registrations for the first year of operation was missed by several weeks, patient sign-ups for the second year have now exceeded the 1.5 million mark estimated by the department in the 20122013 budget papers. Based on international experience, the department hopes to have a further 700,000 registrations by July 2015, which it seems more than likely to reach on current figures but which is dependent on the new government’s still unknown plans for the system.
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According to internal DoH documents seen by Pulse+IT, the vast majority
of these registrations were facilitated by Aspen Medical, which was hired last year to assist consumers to register in general practices and in public hospitals. The figures show that Aspen, whose contract finished at the end of last year, registered over 730,000 people. More than 260,000 have registered online, and another 200,000 through the Department of Human Services’ administration portal. Assisted registration through Medicare Locals and the assisted registration tool, which has been used to sign patients up by healthcare providers, total over 176,000. Registrations for newborns through Medicare’s FA101 forms are also included. While consumer registrations are continuing, figures for uploading clinical documents appear to be well behind.
Electronic discharge summaries have overtaken the number of shared health summaries on the system, by 20,000 to 16,000. More than 200 public hospitals are now connected and are predominantly using it to load discharge summaries. A Pulse+IT source who did not wish to be named said the small number of shared health summaries – the primary clinical document – was a major concern and showed that clinicians in the primary care sector had “disengaged” with the system over perceptions that it had little clinical value and uncertainty over its future remained. Consumers have entered many of their own notes, including over 33,000 health summaries, 11,000 consumer notes and almost 5000 advance care directive custodian reports. The Child eHealth Record (CeHR) – which parents, GPs and community nurses
can access – has over 4000 documents, but none have been entered by clinicians. The National Prescription and Dispense Repository holds almost 95,000
records, over 90 per cent of them dispense documents. Actual viewing of documents seems to be improving with 484 unique providers and 8328 unique
consumers accessing the system in the week of February 26 to March 4. As of March 4, the PCEHR has been used by healthcare providers to view 11,858 clinical documents.
eHealth the focus for next Medical Director release from HCN Health Communication Network (HCN) is planning a mid-year launch for the next release of its clinical and practice management software products Medical Director and PracSoft, with added eHealth functionality the primary upgrades. Assisted registration functionality for the PCEHR, which will allow practices to register patients in person through the software, will be available to users in the next version. It will also come with improvements to the National Prescription and Dispense Repository (NPDR), allowing doctors to access both the prescribed and dispensed view. HCN CEO Phil Offer said there will also be some improvements to the National Inpatient Medication Chart (NIMC), which GPs use if they prescribe for hospital inpatients. “The improvements will allow you to save time by automatically generating multiple sets of NIMC printouts for those with many
regular medications, add more than five allergies on and improve readability, which is quite critical,” Mr Offer said. HCN will also make some usability enhancements to its PCEHR interface following feedback from NEHTA’s clinical usability program (CUP). “We are in the final stages of going through them now and we have been working very deeply with NEHTA to put those changes in,” he said. “It’s more about accessibility to the PCEHR functions so the patient’s PCEHR information can be more easily viewed. Also, the author who is creating their shared health summary is now incorporated.” HCN is also adding some new functions to help GPs with accreditation, he said. “We are talking to the RACGP and hearing that they are tightening their focus on certain areas, so we are improving the ability to record a patient’s ethnicity and issuing that
both in Medical Director and in PracSoft.” The last big release of MD was version 3.15 late last year, which Mr Offer said is now installed in over 70 per cent of the customer base. That upgrade also included the MD Sidebar and Widget Store, which HCN has been working on for several years to allow applications from verified third parties to be added quickly to the software without interrupting the user’s workflow.
Epic wins tender for Royal Children’s Hospital EMR US-based EMR giant Epic has won the much sought-after tender to provide an electronic medical record for Melbourne’s Royal Children’s Hospital. The $48 million contract was announced by Victorian Premier Denis Napthine after a very competitive tender process that is understood to have included all of the major US and local EMR vendors. Epic Systems’ CEO Judy Faulkner is thought to have personally visited Melbourne as part of the bid. Ms Faulkner, who founded the company in 1979 and has since built it into a billion-dollar business, is famously publicity-shy. The company also keeps a low profile and a purposefully small client base in acute care, but also provides software for large medical centres and healthcare organisations in the US. It is also active in personal health records. Dr Napthine said Epic was used in seven of the top 10 paediatric hospitals in the US. It is one of the few EMRs that can achieve HIMSS levels 6 and 7 certifications.
HCN has also added an app that allows GPs to write medical reports for insurance purposes and submit them automatically to UHG, Mr Offer said.
“Epic EMR systems are an exciting new addition to Victorian healthcare,” he said. “The new system will also give parents the ability to interact directly with the hospital using their smart phones to schedule appointments.”
“There are a number of other partners that we are now talking to and we’ll be able to confirm [soon] who the next ones are that we’ll put in,” he said. “We are finding it a really useful way to be able to engage much more with partners and a quick way to be able to bring apps in from the market.”
Health Minister David Davis said it was expected to go live in the middle of the year, with a full roll-out taking four years.“It will enable staff to manage medications, and other patient care activity with real-time decision support that will facilitate best practice,” he said. Another portal will enable authorised GPs, private paediatricians and other providers to view patient records and refer patients electronically.
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PCEHR release five planned for this month Despite the current uncertainty over the future of the PCEHR, plans to include new functionality including pathology and diagnostic imaging reports and advance care directives are still going ahead, with a big release expected this month. Originally planned for April, release 5 of the PCEHR is apparently still on track, with confidential documents seen by Pulse+IT indicating at least one of the major functions will be available. The ability to view pathology results and diagnostic imaging reports is considered a deal-breaker in the value of the system to clinicians, but this functionality has been the topic of much disagreement between the designers and the pathology sector. According to a clinical safety management activity status report compiled by NEHTA for the independent Clinical Governance Advisory Group (CGAG), a minor release was set to be implemented in April to fix a number of known defects in the system and to address issues identified through production use of the PCEHR. The report, dated March 19, shows that NEHTA’s clinical safety unit is working with the Department of Health on a clinical safety assessment of the anticipated scope of release 5, which in addition to pathology results, imaging reports and advance care directives, will also include a health record overview for the provider portal. The Northern Territory’s My eHealth Record (MeHR) was also scheduled to transfer to the national system in April, but it is unclear whether this is going ahead. A report of the Royle review into the implementation of the system, delivered to Health Minister Peter Dutton in December, has still not been released. Pulse+IT has lodged an appeal against the refusal by the health department to release the report under Freedom of Information legislation.
Medicare to act on duplicate and intertwined records The Department of Human Services (DHS) has established a program of work to identify and cleanse the Medicare Consumer Directory of duplicate or intertwined records, which an Auditor-General’s report says can pose a clinical safety risk. The Australian National Audit Office (ANAO) recently released the results of an independent performance audit of the integrity of Medicare customer data. While the report found that the number of duplicate and intertwined records was not significant considering the amount of data Medicare manages, corrective action still needed to be taken. Duplicate records were a matter of concern in terms of the potential for fraud but also clinical safety. The report says that following the introduction of Individual Healthcare Identifiers (IHIs) in mid2010, DHS undertook a data cleansing exercise to identify duplicate Medicare customer enrolments. This recognised the risk that if both enrolments were active and the customer requested a PCEHR, their clinical data would be incomplete as it would only reflect the data recorded on one record, the report says.
Despite this data cleansing exercise, the audit found at least 18,000 possible duplicate enrolments, which posed an ongoing data integrity issue in the Medicare customer database, it said. Another area of concern was intertwined records, defined as a record held in Medicare’s Consumer Directory database which is shared by two different customers. This gave rise to both privacy and clinical safety risks, the ANOA found.
“This gave rise to both privacy and clinical safety risks.” “Intertwined records are created when customer service officers incorrectly enable two customers to use the same PIN – customers’ unique Medicare enrolment identifiers. Human Services advised that it has recorded 34 intertwined records since 2011-12, when it commenced recording identified instances. “These records represent a clinical safety risk to customers as their recorded health data is combined with the health data of another customer. It also represents a privacy
risk if one of the customers views their personal and/ or health data, including claiming history, through a Medicare Online Services account, [PCEHR], Medicare Express Plus mobile phone application account or by requesting a copy of their claims data from Human Services.” The report states that intertwined records are difficult to identify and have been brought to DHS’s attention by customer queries. “For example, Human Services identified one intertwined record for two children after the parent of one of the children received an immunisation certificate for the other child and contacted [DHS].” DHS has responded to the audit by setting up a program to undertake a comprehensive analysis of the Consumer Directory to identify and analyse the extent of intertwined records by June. It has also undertaken to cleanse the directory of any intertwined records by September, and to identify “risk points” for the creation of intertwined records by October. It will also establish a framework to capture intertwined records at the time of creation to allow for prompt corrective action by the end of the year.
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Barwon Health gets set to upload discharge summaries Geelong’s Barwon Health is working on the functionality to upload discharge summaries to the PCEHR, which it plans to do through its BOSSnet clinical information system. Barwon Health’s CIO Ann Larkins said while it was connected through the National Prescription and Dispense Repository (NPDR), it had not yet achieved the eDischarge capability. There are now over 200 public hospitals, both large and small, in Queensland, NSW, South Australia, Tasmania and the ACT to have PCEHR discharge summary capability. Some of those connected hospitals also have the ability to view a patient’s PCEHR either from within clinical software, or in the case of Queensland through its The Viewer portal. Ms Larkins said Barwon Health was very much in the project initiation stage and was just kicking off, but would be allowing its clinicians to upload discharge summaries directly through its BOSSnet clinical information system rather than through the Healthcare Information and PCEHR Services (HIPS) application designed by SA Health and licensed to NEHTA. “We are doing it through BOSSNet because we already have that functionality built in for medications, which have been going up directly to the PCEHR from BOSSnet for the best part of a year,” she said. “We will use that same build to get discharge summaries up as well.” South Australia is using HIPS for its metropolitan hospitals, which have been uploading discharge summaries since last year. NSW is predominantly using clinical information systems, including Emerging Systems’ EHS at St Vincent’s Hospital and the Cerner system used in many other public hospitals.
Exploit vulnerabilities found in CDA do not affect PCEHR core: expert The discovery of a set of vulnerabilities that could potentially lead to malicious content being added to clinical documents created using the clinical document architecture (CDA) standard is not a likely threat to the security of the PCEHR, a CDA expert says. In early April, US physician and programmer Joshua Mandel revealed that he had discovered that certain style sheets used to display CDA documents in many commercially available electronic health record systems in the US could potentially leave those EHRs vulnerable to attacks from malicious code attached to CDA documents. The vulnerabilities are of concern to Australian vendors of EHRs and secure messaging services, which also transfer CDA documents, as well as to the operators of the PCEHR, as CDA is used for all of the clinical documents uploaded to the system. Australian CDA expert Grahame Grieve said Dr Mandel had found the problem in some EHR systems that are in production use, and traced it to an HL7-designed style sheet, derivations of which are used by many EHR vendors as well as in the PCEHR to render CDA documents for viewing.
Mr Grieve said the problem was not an attack on the CDA itself but on the ‘transform’ used to view it. “Technically, CDA is a static XML form that converts it to HTML form that you can write in the browser,” he said. “The way you create this vulnerability is that you insert some content into the CDA that activates during the transform and does things that you do not expect once the HTML is loaded in the browser. So this is not an attack on CDA itself – it is an attack on the transform that people use to view the CDA.” Mr Grieve said that in his opinion, while there was the potential to exploit this vulnerability, the threat profile for the PCEHR was very low. “The PCEHR itself or any other CDA exchange system are completely
unaffected by this. The issue only arises when that transform runs and the documents are displayed ... The PCEHR core itself is not affected. “You can’t just sit at home and try hacking this. You’ve basically got to compromise a certified system. Now that is possible, but it’s much harder work than running scripts that pursue known exploits.” He said there were concerns for software vendors outside of the PCEHR context, including for secure messaging vendors that use filebased transfer to transfer documents from clinical systems to message delivery systems. However, if a hacker wanted to attack the PCEHR, there were much more
straightforward methods than “fiddling” with CDA documents, he said. “This is a hard attack. It is very low efficiency. There are
much easier ways to attack a system if you want to than to do this but what we are saying is that it is possible. [With] the PCEHR it would
be an extremely hard but with point-to-point it would be somewhat easier and people do need to look at that.”
NEHTA and vendors work on improvements to PCEHR interfaces NEHTA has released details of improvements to the software interfaces for the PCEHR following sustained criticism of the system’s lack of usability from clinicians.
It also recommended that administrative data, which is the first thing seen when opening a record, be hidden from the clinician’s view and clinical data shown first.
According to NEHTA’s website, it worked with peak bodies to produce guidance material for software vendors on improvements that could be made under its clinical usability program (CUP).
When creating a shared health summary and filling out the medical history section, NEHTA has recommended that medical history be no longer separated into subgroupings, but displayed as one list in chronological order.
NEHTA said the focus of the first release of the guidance material was specific to improving the usability of the shared health summary and viewing and downloading documents from the PCEHR. The improvements will be made through each vendor’s new releases and are all due to be implemented before June. NEHTA has recommended that certain columns and headings be displayed in clinical documents to allow clinicians more clarity when selecting clinical documents from the PCEHR list view.
“An entry point to PCEHR functionality will be displayed prominently on the patient chart.” A final recommendation is that improvements be made to assist clinicians when checking if a PCEHR exists for the patient. Rather than the clinician having to check themselves, the software will instead search and validate both the Healthcare
Identifier and PCEHR status in the background when the patient’s record is opened. When a PCEHR is found, a record status indicator will turn green and be displayed to the clinician. “An entry point to PCEHR functionality will be displayed prominently on the patient chart,” the organisation said. Department of Health documents show that of the 200-odd consumer complaints made since December 4 last year, over 70 relate to access issues, registration difficulty or requirements for the MyGov website, which consumers must use to register online. There were 22 complaints about the design or operation of the PCEHR between December 4 and March 5, while 15 were recorded for the assisted registration process. One complaint was made on the grounds of privacy with the PCEHR operation, and nine privacy or consent concerns were made about the assisted registration process.
My Film Bag goes live with patient films online Melbourne-based radiology specialist Zed Technologies has gone live in its first practices with its new My Film Bag app, which allows patients to view their radiology images online. Rolled out first at Melbourne’s Imaging @ Olympic Park, the app also went live at Port Macquarie X-ray in NSW as a way to test it with patients who have to travel out of the area to see specialists. My Film Bag is available as both a web app and as a mobile app for iOS and Android devices, and has been developed by Zed Technologies’ Ross Wright and Ronald Li as a way to allow patients to view their own images and to share them with doctors without having to cart around films or CDs. Mr Wright said Imaging @ Olympic Park and Port Macquarie X-ray are paying for the app on behalf of their patients. “Their reasoning behind it is that it’s a value-added service but there’s also a small saving on film,” he said. “It was something that they thought some of their patients would appreciate, being mobile and reasonably tech savvy patients.” In addition to allowing patients easy access to their scans while travelling and the ability to share them with multiple healthcare providers, another obvious market to explore is new parents to allow them to store and view ultrasound images. The company plans to initially market the app to radiology providers before individual patients. The app is the first consumer venture for the start-up company, which has also developed a DICOM viewer currently in use in hospitals as well as a mobile app that can be used with Medinexus to allow GPs and specialists to view DICOM images from within their desktop software or mobile device.
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Start2Talk online tool for advance care planning Alzheimer’s Australia has launched an interactive website to provide comprehensive information and a six-step plan for people wishing to prepare for their future healthcare, lifestyle and financial decisions. Called Start2Talk, the site includes a number of worksheets along with access to information on advance care planning tailored to each state and territory. Users can complete the worksheets online and save them to their computer, and to print them out to give to family and healthcare professionals. By registering online, users can fill in the forms online, save them if they are incomplete and make future amendments. Developed through Alzheimer’s Australia’s National Quality Dementia Care Initiative, Start2Talk is aimed at people with the early signs of memory loss or a diagnosis of dementia, their carers and health and community care professionals who want to promote end‑of-life care planning. It has a number of worksheets that people can view and print out, or fill in online and save. As regulations and forms differ according to state and territory legislation, the website will ask users to indicate which state they are from and the appropriate information will be provided. Family members can also use the site if the person is no longer capable for making their own decisions, and there is a healthcare professional section that also includes tools and resources for patients inquiring about advance care planning. For GPs, it includes a link to Alzheimer’s Australia’s practitioner-focused Detect Early site, which has a tutorial on how to use the General Practitioner assessment of Cognition (GPCOG) screening tool as well as resources for pharmacists.
Computerised CHAT to streamline pre‑operative assessments Royal Adelaide Hospital is conducting a trial of overthe-phone consultations and a computerised questionnaire for preoperative assessments with the aim of reducing unnecessary travel for patients and freeing up session times for surgeons and anaesthetists. Dubbed Computer Health Assessment by Telephone (CHAT), the trial involves a comprehensive questionnaire that is conducted over the phone by a non-clinical healthcare worker that fully documents the patient’s requirements, and obviates the need for them to attend outpatients for a face-to-face consult. The CHAT pre-screening model is based on previous studies led by the head of acute care medicine at the University of Adelaide, Guy Ludbrook, and his colleague Cliff Grant, as well as WA anaesthetists Tomas Corcoran and Ed O’Loughlin. Their study of more than 500 patients scheduled for elective surgery found that the quality of assessment provided by a non-clinician telephone interview was comparable to a face-toface interview by trained anaesthetists, and often more comprehensive. “What we came up with over time was a really
big questionnaire that effectively became a very large pre-operative checklist,” Professor Ludbrook said. “Knowing and understanding the benefits of surgical checklists such as the WHO checklists, we wanted to expand that dramatically so we really needed computers to do that. “Secondly, we needed a means of interaction that was practical. Just about everyone has a telephone so that allowed us a very easy first contact point. It’s often not the last, but it is the first.”
“[It’s a] really big questionnaire that effectively became a very large pre-operative checklist.” Professor Ludbrook and his team have built up the questionnaire through an iterative process, starting with anaesthesia and then bringing in surgery, medicine and pharmacy requirements. “What we discovered, not surprisingly, is that there is an enormous amount of overlap and redundancy in what we do already.
“Our craft groups are often working in parallel and that doesn’t always make the most efficient sense, so by getting together we discovered that in fact we can reduce the workloads substantially by combining a lot of these questions and answers.” The team has built its own software for the questionnaire, as nothing on the market was quite right for CHAT’s requirements. The questionnaire has grown to contain about 500 questions with 1500 fixed responses, and more are expected. A nurse or a trained receptionist conducts the phone interview, which usually takes about 20 minutes, and enters the responses through a touchscreen into a database. Professor Ludbrook said the team did consider fully automating the system – and it definitely has that potential – but the capabilities of the patients have to be taken into account. “They have to navigate what is a pretty complex questionnaire and it does help to have people take you through it. We are often dealing with the elderly; some are IT friendly but some are not and some have internet access but some don’t. Some have good vision and some don’t.
Secure MessagingTransforming Healthcare HealthLink delivers on the promise of ehealth reform through standards compliance and nationwide secure messaging. “There are also very complex issues to be dealt with in terms of access, privacy and so on, so we are taking this one step at a time. An 18-year-old would whizz through it but someone who is 80, perhaps not. We feel at this stage that we are going to walk before we run.” Much of the IT work was done by Mr Grant, who also worked on how to tailor the various reports that each craft group – including nursing, pharmacy, surgery and anaesthesia – needs, Professor Ludbrook said.
“That information may come from the same pool but we need to give out what’s relevant and concise and laid out well. That’s actually another IT challenge in itself. We ended up building it ourselves in a draft version and then it had more professional people involved in getting it into better shape, which is good because it has ended up being fit for purpose.” Various clinicians can access the completed information in PDF form, but it is predominantly
distributed to the different clinical groups on paper. “We are not a paperless hospital and to be quite frank, having bits of paper is actually quite helpful because we have paper case notes,” he said. “It is accessible electronically and therefore stored but again, we walk before we run. We have the capacity to be electronic and we will have it on our central SA Health servers soon to be able to do that, but we are taking this step by step.”
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Chris O’Brien Lifehouse chooses MetaVision for critical care units ICU specialist iMDsoft has won a bid to install its MetaVision clinical information system in the critical care and perioperative units at the Chris O’Brien Lifehouse cancer centre in Sydney. MetaVision, which last year was selected by NSW Health to be installed in all ICUs in NSW public hospitals, is used in six Queensland public hospitals and is also being rolled out at the Royal Brisbane and Women’s, Princess Alexandra and Royal Children’s hospitals. It is also in use at the Canberra Hospital and Calvary Hospital in the ACT, and Macquarie
University Hospital and Sydney Adventist Hospital in Sydney.
functionality, which enables tracking and prioritising of activities across care units.
The $260 million Lifehouse, which is situated at the Royal Prince Alfred Hospital campus in Camperdown, opened its doors to patients last November and includes an integrative medicine centre called the Lifehouse LivingRoom.
MetaVision is interoperable with most of the leading hospital information systems and is able to capture information from the vast range of medical devices used in ICU. It also has advanced medication management capability and minute-by-minute patient data collection and display.
The next phase of the centre’s development will see surgery and ICU open this year and next. MetaVision will be implemented as a full-featured clinical information system in ICU and anaesthesia and will include iMDsoft’s new cross-patient management
Lifehouse CIO Anne Marie Hadley said the organisation chose to implement MetaVision as it provides a flexible, datarich information system at the point of care and will evolve with long-term organisational needs.
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Mobile devices create “hospitals without walls” The early adoption of mobile devices and other technologies in rural general practice has boosted the uptake of telehealth, but the sector needs to turn from a focus on doctors to a focus on patients and communities, a leading telehealth expert says. Richard Murray, president of the Australian College of Rural and Remote Medicine (ACRRM), told the Australian Telehealth Conference (ATC) in Melbourne that telehealth allowed the development of “hospitals without walls” in rural and remote areas, and there was a positive outlook for further growth in the industry. “The rise of the mobile device has meant that bridging the rural-city divide through telehealth has become easier,” Professor Murray said. “Traditionally, doctors in rural and remote Australia have been the early adopters and champions of health technology. They’ve done so out of necessity and necessity has always been the mother of invention. And because of this commitment to innovation and invention, Australian telehealth is at the forefront of the industry.” However, he said there is still room for improvement. “We need to deliver telehealth services that are patient and community-centred rather than doctor‑focused. “The services must certainly be tailored to rural generalists by being team-based and technology-enabled, but the end game must be to provide rural communities with holistic care. We must consider the larger picture in order to create a ‘system of care’... “If we continue along this path, but commit to patient-centred care, it will result in an authentic and useful service for our regional and remote communities.”
Instadok to launch mobile video consultation platform with scripts Melbourne-based company instadok is preparing to launch an early prototype of its new telehealth platform, collaborating with appointment booking service HealthEngine and prescription exchange service MediSecure to provide a completely mobile video consultation service. instadok is targeting the nascent paid remote GP consultation market, planning to recruit 20 general practices in Melbourne to test its minimum viable product (MVP) before launching a beta version in a few months. The alpha release of instadok’s platform is designed for Apple mobile devices and will include a pre-configured iPad for
doctors and an iPhone app for patients through which they can manage appointments, attend the video consultation with the doctor, have prescriptions sent to their home or nominated pharmacy and pay using a credit card.
from voice to text and attached to the GP’s patient record. As part of the beta phase, instadok will look at integrating GP practice management software with instadok’s electronic health record and prescription management system.
instadok managing director Ganesha Rajanaidu said the platform was aimed at closing the loop in the primary care market by giving patients in metropolitan areas access to remote GP consultations and fulfil prescriptions.
Mr Rajanaidu said the idea was to bring together services that have emerged over the last few years in the primary care sector, such as HealthEngine for online booking and MediSecure for electronic prescriptions, into a new vehicle to service both existing and new patients.
The plan is to add an electronic health record feature that allows the patient to view previous consultations. For doctors, the plan is for the video consultations to be automatically transcribed
“There are electronic appointment and prescription fulfilment companies, but in the middle of that is the remote consultation piece, which
we think is underserved,” Mr Rajanaidu said. “We take a user-oriented approach, focusing on the user experience and from
this perspective, we believe that there is an opportunity to improve. “From a user experience point of view, the idea is to
use mobile devices to make the bookings, perform the remote consultation as well as get your prescriptions fulfilled, within the same workflow.”
DocAppointments extends app suite with patient demographics and survey app Online appointments booking service DocAppointments has added a patient demographics and survey app to its product suite that integrates with Best Practice and PracSoft to create a new patient file. The app allows new patients to fill out their personal details on a tablet while waiting for their appointment and for existing patients to update theirs, freeing up reception staff for other tasks and promising to reduce data entry errors. It also allows practices to conduct surveys while the patients are waiting, including accreditation and patient satisfaction surveys, which might also help to reduce waiting time irritation. When a new patient comes to a surgery, they are handed a tablet to fill in their personal details. When they are finished the app is locked and they are told to take it back to the receptionist. The receptionist puts in a code,
checks that the details are correct if necessary, and then clicks save. The app will then immediately create a new patient file in PracSoft or Best Practice. DocAppointments founder Calin Pava said the app does the same for existing patients with the difference that the receptionist puts in the ID of the patient, the app extracts existing details, the patient can then check or change them and then the receptionist authorises the change. “We believe it reduces the time from four and a half minutes to less than one for the receptionist,” Dr Pava said. “Errors will be reduced and there are no privacy issues either.” The app has been developed for Android tablets as they tend to be the cheapest models, and DocAppointments is charging a flat $250 per annum fee for the app to practices. Dr Pava said the next practice management software package he hopes to integrate with is Stat, and, depending on demand,
he will look at integrating with other GP software. In addition to filling out personal details, the app also has the capacity to allow practices to design their own surveys. “They can put in whatever question they want, and as many questions as they want, and as many surveys as they want,” he said. “For their accreditation, practices have to do a survey, so instead of doing them on paper you can do them on the tablet. In addition, practices might be interested in doing quality surveys on how their patients are going and whether they’re happy or not, and we’ve discovered that it can also be used when a doctor is late. “The receptionist can give the patient a tablet and ask them to update their details, and to help the practice with a survey while they are waiting for the doctor. That can take about 10 minutes and the patient is happy that they doing something useful instead of getting irritated.”
Text messages can help with vaccination safety monitoring A West Australian research team has developed a tool that can extract patient data from practice management software and send an SMS query to patients to conduct active adverse events following immunisation (AEFI) surveillance. Designed by software developer Ian Peters of Datavation, who also developed the Canning clinical data extraction tool, SmartVax has been used in a study published in the Medical Journal of Australia that shows simple SMS messages can allow general practices to accurately monitor vaccine safety. The study, conducted at the Illawarra Medical Centre in Perth, was conducted between November 2011 and June 2013. It involved 3281 patients who had received one or more vaccines: 32 per cent were adult patients who received a flu vaccine and 68 per cent were paediatric patients who received scheduled vaccinations. An SMS was sent to patients vaccinated within the preceding seven days. For adult patients, 69.8 per cent replied to the SMS, 92 per cent replying no and 7.6 per cent replying yes. For paediatric patients, 73.9 per cent of parents replied to the SMS, 86.9 per cent of whom replied no. Those who replied yes or didn’t reply to the SMS were followed up by a phone call. Half of all patients responded within 10 minutes of receiving the SMS, and more than 80 per cent within two hours. The SMS replies were automatically written back into the SmartVax tool, linked to the patient’s vaccination data and collated in real time. The study team typically waited for 24 hours to receive a response before calling those who hadn’t responded or had indicated a reaction. Clinical staff were then able to administer a survey to ascertain the nature, duration and severity of any reaction reported.
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HealthEngine to integrate with Yahoo!7 health site Online health directory and appointment booking service HealthEngine will be integrated into the Yahoo!7Lifestyle website, a joint venture between Yahoo! and Seven West Media that provides health-related content for consumers. While details of exactly how the integration will look are still being worked out, HealthEngine CEO Marcus Tan said it will probably work in the same way that realestate.com.au does for the Yahoo!7 real estate section. Seven West Media took a stake in HealthEngine along with Telstra in a joint investment worth $10.4 million in May last year. Seven West Media, which owns a newspaper and consumer magazine publishing business in addition to its TV network, has been actively targeting the consumer healthcare market. HealthEngine, which started off in 2006 as an online directory for GPs to find medical specialists, added online booking functionality for patients in early 2012. It offers a fee-per-appointment model. The HealthEngine website registers more than 500,000 unique visitors every month and it can also be integrated into practice management software, including Best Practice, PracSoft, Genie, Zedmed and allied health practice management specialist Cliniko, for those practices wanting to offer the convenience of online bookings to existing patients. Dr Tan said HealthEngine now had as many if not more allied health and dental practices listed for appointments as general practices. “I’d say half if not more are in the allied or dental space,” he said. “It is a bigger part of the market than GPs but GPs are the core in terms of driving referrals to allied health.”
Renewed calls for real-time prescription drug monitoring system The Victorian branch of the Australian Medical Association (AMA) has renewed its recent calls for the expedited roll-out of the proposed national real-time prescription drug monitoring system at the Victorian Pharmaceutical Misuse Summit, held in Melbourne recently.
Better known as the Electronic Recording and Reporting of Controlled Drugs (ERRCD) system, licences for the Tasmaniandeveloped software were purchased for the states and territories by the former Minister for Health Tanya Plibersek in February 2012.
Convened by the Victorian Department of Health, the summit brought together 90 representatives from the health sector, including the Pharmaceutical Society of Australia, the Pharmacy Guild of Victoria, Turning Point Alcohol & Drug Centre and the Victorian Alcohol and Drug Association (VAADA).
As the regulation of the prescribing and dispensing of controlled drugs is the responsibility of the states and territories, changes to legislation and reporting processes are required in each jurisdiction.
Speaking in advance of the summit, AMA Victoria president Stephen Parnis said the Victorian Coroners Court had shown that in 2012, 304 Victorians died from prescription drug overdose, more than the state’s road toll of 282. Another 176 people had died from drug overdoses, 82 per cent of which were the result of prescription drugs, in the first half of 2013. AMA Victoria has been actively campaigning for the introduction of the realtime monitoring system as part of a raft of programs aimed at reducing prescription drug misuse.
“AMA Victoria has been actively campaigning for the introduction of the real-time monitoring system.” A spokeswoman for the federal Department of Health told Pulse+IT that ERRCD is currently installed on a secure host server and is operational, waiting for each state and territory to commence use. “The ERRCD system has been handed over to states and territories for their use via complimentary software licence agreements.” A spokesperson for the NSW Ministry of Health
said the department was currently working through the financial and practical implications of implementing ERRCD, and that a full roll out is likely to take three years. “There may need to be changes to legislation to require the provision of pharmacy dispensing records of controlled drugs and to enable access to records by medical practitioners and pharmacists,” the spokesperson said. Western Australia currently has a bill before state parliament that will support required changes to laws governing the collection, sharing and protection of personal data, but a WA Health spokesperson said there was still a lot of technical and administrative work that needed to be done before software can be rolled out. Queensland, meanwhile, is looking at what modifications the system might require and whether it can run in conjunction with its existing Monitoring of Drugs of Dependence System (MODDS). The system has been rolled out in Tasmania, but the Victorian and South Australian governments are still being lobbied by local AMA branches for news on its introduction.
14 May 21 May 27 May 28 May 3 June
Business continuity plans #1 Business continuity plans #2 Triage Practice equipment Safe and quality use of medicines 4 June Cold chain management 10 June Sterilisation 18 June Pandemics
Bits & Bytes
MEDrefer integrates with Genie for specialist referrals Online referral tool MEDrefer has integrated with Genie Solutions, allowing specialists using Genie to display their availability in the MEDrefer profile directly from their appointment book. MEDrefer is also fully integrated into Best Practice clinical software for GPs, and the company is currently in discussions with other GP, specialist and allied health software vendors to expand its reach. MEDrefer is a web-based platform that allows GPs to search a directory of specialists and allied health providers by their sub-specialties, location and availability and other factors like gender or languages spoken. GPs can book an appointment for their patient then and there, or provide the patient with a referral certificate listing up to five specialists from which the patient can choose the most appropriate for their schedule and location. MEDrefer managing director Brian Sullivan said the referring doctor does not need to write five referral letters to five different specialists. Instead, one referral letter sits in the MEDrefer system awaiting the accepting specialist to take up the referral. Once accepted, the letter is then addressed to that specialist. It is available for free to GPs, and uses a system of credits for specialists and allied health practitioners to register and accept a referral. It has a directory of over 18,000 providers, but also allows GPs to list preferred specialists through the practice’s existing database. GPs are able to track the status of the referral through email notifications. For Best Practice users, the report is delivered straight into the system, but other software users can still use the online portal to track their referrals.
Queensland disability groups build a social eHealth record Eight Queenslandbased disability service providers have formed a partnership to roll out a shared electronic health and personal record to streamline care management for their clients and to keep all of their information in one place. The organisations have formed a limited company called G8EHR to set up the system, which is based on Extensia’s RecordPoint shared electronic health record. It is being adapted to allow existing social and personal records to be scanned in, along with assessment tools such as an electronic version of the University of Queensland’s Comprehensive Health Assessment Program. The eight organisations – the Endeavour Foundation, Multicap, Cerebral Palsy League, Life Without Barriers, Centacare, Uniting Care Community, FSG Australia and Spinal Injuries Australia – have also contracted the Improvement Foundation to assist with change management and to improve uptake of the system, which they are calling the My eRecord. Multicap CEO Jo Jessop said the impetus behind the development of the system was the common refrain from people with disabilities
and their families that they get tired of telling their story over and over again to a new healthcare or service provider. “We all have shared clients, we all support people who also access services from other organisations and we were talking about how we could make it easier for our clients and for ourselves in capturing and not losing that information,” Ms Jessop said. “We thought there must be some way that we can share information in a way that is secure.”
“Multicap has clients who’ve been with us from the start, and we’ve been in existence for 52 years.” While RecordPoint is a shared health record, it is being used in this project for much more. “We are using it as a social record and that’s why it’s called My eRecord,” Ms Jessop said. “It is designed to allow a person with a disability and their family to save in a central place their stories, information that is relevant about themselves, as well as their health information.
“For many of our clients that have multiple disabilities, who cannot speak, who have challenging and complex behaviours, it is a place to keep that information so it doesn’t get lost. Multicap has clients who’ve been with us from the start, and we’ve been in existence for 52 years. It’s designed to keep all of that information so that it lasts beyond us.” While the individual and their family are in control of the eRecord, they are able to select a care team to whom they grant access, including their GP, specialists and allied health professionals as well as their service providers. Extensia has developed a plug-in adapter called RecordConnect that allows users of medical systems such as Medical Director, Stat, Best Practice, Communicare and practiX to integrate with RecordPoint. Ms Jessop said this would allow GPs to upload information to the My eRecord automatically, and let allied health professionals to add notes. “If the GP software is linked up to RecordPoint, a flag comes up to show that the person has got a shared record. They can then log in and have a look and they can update anything that they might need to through that system.”
“Intelligent paper on glass” mimics clinical workflows Despite more widespread use of electronic medical records, paper forms still proliferate in the acute care sector, often because they have been designed over several years to fit in with clinical workflows and can prove easier to use than electronic systems. Software is now available that can mimic current patient care processes and paperwork, enabling capture of information on existing paper forms in a structured digital form, without changing current work practices. Irish software company Slainte Healthcare has recently worked with two Australian organisations – the new Chris O’Brien Lifehouse cancer centre
in Sydney and Calvary Health Care Bethlehem in Melbourne – to implement its Vitro intelligent paperless chart. Vitro is able to replicate any existing paper form and includes pre-defined workflows that clinicians regularly use. The forms allow them to do electronic signatures and drawings, and typing, dictation or ‘hand-written’ notes using the cursor. Handwriting is converted to text and entered on the form. This approach of automating forms can help eliminate the need to scan paper records. As a web-based system, it can be used on mobile devices, or what Slainte calls “intelligent paper on glass”.
At the Chris O’Brien Lifehouse, clinicians and pharmacists have changed their chemotherapy manufacturing process and improved medication management by using the software. The system was given the green light in December last year and went live in February. It is automating the creation of a chemotherapy worksheet, covering workflow processes online, administration, preparation, manufacturing, final check and dispensing by pharmacy staff. The Calvary Hospital Group is also implementing the same software to track the patient journey as part of a transition to a comprehensive EMR. The first pilot implementation is in palliative care, at Bethlehem in Melbourne, and will mimic existing procedures and documents to enable an electronic record to support the way that the hospital staff currently work. The new approach offers the potential to rapidly move to a paperless environment, in effect what might be called an “EMR lite”, where each patient’s information, and all information systems, can be integrated and accessed online by all appropriate clinicians.
Interactive medicines list part of Parkinson’s Passport Parkinson’s Australia and NPS MedicineWise have developed a pack of materials including interactive medicines lists and checklists for people with Parkinson’s disease to help avoid medicine problems. The interactive Parkinson’s Passport can be downloaded from state Parkinson’s association websites or the NPS website and includes an editable PDF of a medicines list that can include the names of all medicines the person with Parkinson’s is taking, including dose and administration times. There is also an editable PDF symptoms management checklist that allows users to tick a box indicating common requirements of people with Parkinson’s, including if they have swallowing difficulties, they need help with turning in bed or with managing pain, and if they have associated symptoms such as tremor, constipation, memory problems, anxiety or depression, or hallucinations or psychosis. It also contains editable contact details for a patient’s next of kin, neurologist, GP and Parkinson’s nurse. The medicines list is intended to be reviewed regularly in association with the patient’s GP, nurse and pharmacist. The idea is to keep all of these documents in printed form as part of the Parkinson’s Passport, which also includes a plastic card stating that the owner needs to take their medicines on time and that there are contraindications with common drugs such as anti-nausea medications. Parkinson’s Australia and NPS are encouraging people with Parkinson’s to take the passport with them when they enter hospital or an aged care facility, and to also carry a simple card explaining they have Parkinson’s for use in emergencies.
Bits & Bytes
Resources for GPs managing patients with chronic pain NSW’s Agency for Clinical Innovation (ACI) has developed a new website devoted to providing information to patients and practitioners on how to manage chronic pain. Produced by the ACI’s Pain Management Network, the website is part of NSW Health’s $26 million Pain Management Plan, released in July 2012. The website provides full access in one place to pain assessment tools that can help GPs complete GPMPs and TCAs for a pain management plan, such as the Abbey Pain Scale for older people and the RACGP’s silver book. It also has resources for paediatric patients and psychological services, as well as links to information on the MBS item numbers available for referrals to allied health for chronic disease management and recommendations and guidelines for opioid prescribing. There are also numerous fact sheets that can be downloaded and printed off for patients, as well as resources that patients can undertake themselves, including educational videos and templates for pain management diaries. Co-chair of the Pain Management Network Chris Hayes said there was growing recognition that pain-related nervous system changes are potentially reversible. “[We] can teach people with chronic pain to use the latest scientific knowledge to change outcomes, to ‘retrain the brain’’ and wind down the sensitised nervous system that underlies chronic pain,” Dr Hayes said. “The overall aim of the ACI’s initiative is to empower consumers and healthcare professionals working in the community with the latest scientific knowledge to understand chronic pain and how to manage it.”
Repository to capture biomarker metadata for mental health research Melbourne-based data management systems specialist Arcitecta is working with the Cooperative Research Centre (CRC) for Mental Health to build a webbased repository for clinical observation studies that will open up huge amounts of research data to the 19 different organisations involved in the CRC. The repository will be used to capture, access and query clinical observation data from longitudinal studies of biomarkers, which form the basis of the research being done by the CRC for Mental Health to identify indicators of the early onset of Alzheimer’s, Parkinson’s, schizophrenia and other mood disorders and psychoses. Data sources include the CRC’s bio-banks of blood and tissue samples, complex MRI data, gene sequences and the results of proteomic studies, and data from clinical observations. Arcitecta will use its Mediaflux metadata management platform, which can handle both structured and unstructured data, as the basis of the repository. Arcitecta’s software allows researchers to build their own interfaces to access the repository and which present data to clinicians, lead investigators and study
coordinators in a way that is intuitive and easy for them to use, the company says. It also has a mobile application to enable clinicians such as nurses and other members of a study team to capture data at the bedside. This will be able to be entered directly through the app if the nurse is visiting study volunteers at home, or collected manually and entered into the repository at the conclusion of the home visits.
“Users will be able to enter data directly into this web-based repository.” However, the web-based repository will be the primary source of data from the CRC ’s clinical observation studies, lead bioinformatician Noel Faux said. “The focus of this project is to make the collection, access and management of clinical observation study data easier for the users involved in these studies, to reduce the time between the data being gathered and the insights gained from it. “For example, we previously considered schizophrenia to be a single disease. As a result of being able to
assess the information gained from longitudinal studies into this condition, we now know there is a spectrum of schizophrenia that people experience. “It is easier to uncover this sort of information from bigger data points, which is something the development of the web-based repository and mobile app will make possible.” Data currently stored in various programs, including legacy databases and spreadsheets, will also be able be stored in the repository, Dr Faux said. “It basically enables users to pull all sorts of different data together in one place, making it easier to analyse, share and manage. “Users can then either continue using their individual clinical studies software, or enter data directly into the central repository using the webbased interface.” The interface will be used to develop specialised versions of the repository, based on a generic template created by Arcitecta and underpinned by Mediaflux. Arcitecta CTO Jason Lohrey said the Mediaflux platform will work as a repository, a database and a clearinghouse, with the data ‘cleaned’ on entry.
“It provides one point of access for all data, based on an application that sits on the web and connects to the Mediaflux server, so data can be accessed from anywhere,” Mr Lohrey said.
Arcitecta is currently in the early stages of building the product to the CRC for Mental Health’s specifications for delivery and implementation within 12 months.
It will be promoted through the CRC for Mental Health consortium and its global alliance with high performance computing firm SGI and tested in multiple clinical settings.
CSIRO investigates the digitally enabled health system of the future CSIRO has released a report on how digital technologies can help solve some of the most pressing issues facing the healthcare system, forecasting that technologies that are in their infancy today will become the norm in the next decade or so. Written by researchers from CSIRO’s Digital Productivity and Services flagship, The Digitally-enabled Health System report looks at how the Australian health system can reduce costs and deliver quality care through the use of digital technology. The report canvasses several technologies that CSIRO is currently working on, including the use of telehealth for rural healthcare delivery, predictive modelling technologies that are currently in use for patient flow forecasting in hospitals but can be extended to the community, and using the vast amounts of clinical data already collected in more meaningful and effective ways.
Lead author Sarah Dods said the organisation was looking at how the tools of the digital economy can make a difference in health service delivery in three different areas. These include increasing access to services, particularly in rural and remote areas, through the use of broadband and mobile communications; increasing productivity in health service delivery by using demand forecasting and scheduling tools such as its Patient Admission Prediction Tool (PAPT) ; and developing tools to improve clinical data quality through finding better ways to share and access patient information. Dr Dods said nationally available broadband that offers reliable, high speed connections across the country opens up some really good possibilities in rural health, particularly in terms of delivering services to remote clinicians. “Are there ways that we can help rural clinicians
be trained so you can train them in place without them missing out on special opportunities?” she said. This is an active area of research for CSIRO, particularly around wearable computer technologies. While it is in its very early scoping phase, Dr Dods said CSIRO is looking at how it could repurpose existing technology it developed for the mining industry to remotely guide healthcare workers in the clinic. This involves a gesturebased, virtual reality device that engineers use to show remote mine workers how to use complex equipment. “We are also looking at technology we developed to help kids around Australia experience the Australian National Museum remotely. We want to use that to help interns, for example, in rural areas to take part in city hospital rounds. That’s very much a concept as well but it’s a funky piece of technology and it’s out there.”
Bits & Bytes
PwC to run safety audit on PCEHR discharge summaries PricewaterhouseCoopers has been selected to conduct a clinical safety audit looking at the accuracy and quality of data included in electronic discharge summaries uploaded to the PCEHR. A PwC audit team will inspect de-identified records and make site visits to selected hospitals in the jurisdictions sending discharge summaries to the system. The audit team will also look at actual use of eDischarge summaries by healthcare providers, the presentation of data, any errors in the system that could lead to the storage of incorrect information, and the effect this might have on patient safety. This is the fourth such audit conducted since the system went live in July 2012 and is part of the remit of the independent PCEHR Clinical Governance Advisory Group (CGAG), which was set up by the Australian Commission on Safety and Quality in Health Care (ACSQHC). PwC also conducted the third clinical safety audit, a draft of which was discussed at a quarterly CGAG meeting last December, although none of those audits have been released publicly. According to documents seen by Pulse+IT, the third audit involved a survey of pharmacists as well as site visits and analysis of 112 de-identified PCEHR documents, along with interviews with peak organisations. The audit report subsequently made 15 recommendations to improve the clinical safety and governance of the PCEHR. Commission CEO Debora Picone said that all issues raised in that audit could be resolved. The draft fourth audit report is due to be complete for consideration by CGAG at its next quarterly meeting on June 6.
Hybrid cloud solution extracts data from disparate dental practice systems Local cloud integration firm Breeze has worked with dental clinic group Dental Corporation to implement several Microsoft technologies that can extract data from different dental practice management software programs and send it back to headquarters in near real time.
financial data for each practice was emailed or faxed back to headquarters every six weeks, where it was manually entered for analysis. Dental Corporation’s Kellie King said the organisation wanted to streamline this, but hit the roadblock of multiple practice management systems.
were working on different versions of Windows, including some still on XP.
Dental Corporation, which is owned by Bupa and is active here, in New Zealand and in Canada, owns 220 dental practices in Australia. It has an acquisition model, buying practices and managing their financial and administrative needs while the dentists concentrate on their patients.
“All of the dentists have their own practice management software and there are about 15 types of software out there with many, many versions,” Ms King said. “They are very attached to their software and have all of their clinical notes in there, so they are very reluctant to change.”
Before the implementation of the Microsoft solution,
Adding to the complexity was the fact that practices
Microsoft-aligned cloud integration firm Breeze devised a hybrid cloudbased solution using its Cloud Data Manager product, Microsoft’s Azure cloud platform and its BizTalk Server. Cloud Data Manager has a dataextraction program coded in .NET that sits on each practice’s local network and captures certain data as it is updated.
Ms King that rather than impose its own chosen practice management package, the company wanted to find a way to extract the needed data simply without disrupting the dentists’ workflow.
Breeze’s CTO Mick Badran said the tools run in the background so they don’t interfere with the day-today management of the practice. “What we have done is identified the right areas to
go and fetch data, and we send the changes to that data up to the cloud. “It is sent up securely through the cloud and then it arrives at Dental Corp’s back office system through BizTalk Server.”
Mr Badran said the data collection agent itself can be centrally managed, so if there are updates to the individual practice’s locally installed software, Breeze technicians can access a central portal and reconfigure it remotely.
Penelope the first case management system to link to the PCEHR The Penelope client and case management system from Canada’s Athena Software that was implemented last year for the Department of Veterans’ Affairs (DVA) counselling service has successfully linked to the PCEHR. Penelope, which is also used by a number of Medicare Locals to support community and mental health programs such as ATAPS, Closing the Gap and Partners in Recovery, has passed NEHTA’s compliance, conformance and accreditation (CCA) process. Authorised users can now obtain and validate a client’s Individual Healthcare Identifier (IHI), view a shared health summary and upload a discharge summary at the end of an episode of care. Penelope was chosen last year to replace the bespoke management information system known as VMIS that was used by the DVA’s
Veterans and Veterans Families Counselling Service (VVCS) which provides mental health counselling programs to veterans, peacekeepers and their families. Penelope was deployed within four months by Athena Software’s Australian and New Zealand implementation partner, IT consulting firm Sinapse. Sinapse partner Noel Thurlow said Athena Software has about 17,000 users worldwide and in Australia interfaces had been developed to enable reporting to government departments such as the Department of Social Services, which also covers the DVA. Penelope has also been implemented by a number of Medicare Locals for some of the mental health and community health programs they support, including most of the NSW Medicare Locals, Mr Thurlow said. The first
implementation was with WentWest early last year. Sinapse, which has recruited former Pharmacy Guild national president Kos Sclavos as an associate partner based in Brisbane, is also in talks with Medicare Locals in other states to implement Penelope for their community and mental health programs. Mr Thurlow said Penelope is a cloud-based solution that can be used on any device, meaning the psychologists and counsellors contracted by the DVA or referred to by doctors for ATAPS can access it anywhere. Psychologists and case workers who are authorised to use Penelope will have to apply for the HPI-I credentials to view the PCEHR. They won’t be given access to the full medical information, but predominantly to the summary information held on the PCEHR, he said.
Silver surfers seeking digital options for health info Accenture has released the results of a global survey of older people and their attitudes towards digital healthcare technology, finding that while older Australians would like to use technology such as electronic reminders and online prescription refill requests, they rate the importance of such online services lower than consumers in other countries. The survey is part of ongoing analysis of research that also surveyed doctors’ attitudes towards allowing patients access to electronic medical records and consumer attitudes to the same. The consumer research involved over 9000 people in nine countries, of which 1000 were aged over 65. Of those older people, 63 per cent are seeking digital options for managing their health, the survey found. Although 77 per cent of seniors surveyed say that online access to their health records is important, only 17 per cent say they can currently access them. The survey found that Australian seniors predominantly wanted access to technologies such as electronic reminders (68 per cent) and online prescription refill requests (55 per cent), but that only 18 per cent of healthcare providers currently offer such capabilities. Half of respondents want to be able to email healthcare providers, but only six per cent say they currently have that capability. Leigh Donoghue, managing director of Accenture’s health business in Australia, said that older Australians are increasingly online and digital tools were giving them more options to manage many areas of their lives from home, including virtual healthcare services. “Healthcare providers must expand their digital options if they want to help their senior patients more actively participate in their own care,” Mr Donoghue said.
HISA WA COMMITTEE MEETING Perth, WA p: +61 3 9326 3311 w: www.hisa.org.au/events
HEALTH INFORMATICS: NURSING IN THE DIGITAL AGE Brisbane, QLD p: +61 2 9745 7500 w: www.acn.edu.au/cpd
7TH ANNUAL PHARMACEUTICAL LAW CONFERENCE 2014 Sydney, NSW p: +61 2 9080 4090 w: www.healthcareconferences.com.au
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HISA VIC COMMITTEE MEETING Melbourne, VIC p: +61 3 9326 3311 w: www.hisa.org.au/events
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13TH ANNUAL HEALTH INSURANCE SUMMIT Sydney, NSW p: +61 2 9080 4307 w: www.informa.com.au
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TELEHEALTH IN COMMUNITY AGED CARE SUSTAINABLE MODELS REQUIRED
The vast majority of older people want to remain independently in their own homes as they age, which has the benefit of being a cheaper option than institutionalised care. Technology is a means to support this end, but sustainable models for funding telehealth in the community aged care setting are required.
PETER YOUNG Managing director DCA eHealth Solutions firstname.lastname@example.org
It is no secret that governments are spending more on health and aged care and costs are expected to continue to grow faster than the rest of the economy. The 2010 Intergenerational Report was a wake-up call because it projected that by 2050, unless there are significant policy changes, we will be spending increasing and unsustainable amounts of our GDP on healthcare, putting pressure on the rest of the budget. The demand for health and aged care is increasing as more of us will be older as a proportion of the population, but it is also a result of improved treatments, technology and services that people want to access to let them live longer and healthier lives. The most expensive and complex services are those delivered in hospitals and institutions, such as nursing homes, and whilst it is reassuring that this professional care is accessible when needed, we avoid going there if we can, and older people are no exception.
About the author Peter Young is managing director of DCA eHealth Solutions, a subsidiary of Telstra Health. He has over 15 yearsâ€™ experience in solutions design and development for the community care sector, and is currently a board member of the Medical Software Industry Association.
Most Australians prefer to remain in their own home and community as they age and choose to live independently as long as they can. There is strong evidence that being able to remain at home also increases life satisfaction, enhances positive well-being and keeps people healthier through better continuity of care
Evidence also substantiates reductions in health and aged care costs when people are able to age in their own homes and communities and thus defer the time they enter residential or hospital care or avoid such care altogether. However, the rapid growth in demand for in-home services cannot easily be met by simply hiring more staff and conducting business as usual. With community care workers themselves ageing, there is an insufficient supply of trained staff to meet demand and it is a costly option. Governments will need to put considerable pressure on agencies to reduce unit costs to ensure they deploy qualified staff more effectively and achieve greater overall efficiency. The Living Longer Living Better policy framework also introduces a new funding model based on consumerdirected care (CDC), which will provide resources directly to clients so they can choose the service options that best suit them.
Proven benefits of telehealth There is significant opportunity to use innovative technologies to improve staff productivity, improve the quality of in-home care and meet community expectations for contemporary service options tailored to individual needs and circumstances. Telehealth, in its various
delivery modes as videoconferencing, home health monitoring, passive surveillance or wearable alarms, has a central role to play.
“Community telehealth solutions need to be designed for use by people with low technical acuity.”
Over the past few years, a number of telehealth pilot projects have been implemented through specific government research grants, including those related to the NBN rollout. These pilots have demonstrated a number of benefits:
• Videoconferencing into the home can dramatically reduce staffing and travel costs for activities such as medication administration, case conferencing and client education without compromising the quality of care • Monitoring devices, with information sent electronically to care providers, will enable clients to stay at home and avoid unnecessary and costly admission to hospital or residential aged care • Families remotely located from their loved ones are kept informed about their condition, can be engaged in their care planning and have greater peace of mind • With the right support older people appreciate the way new technologies help them manage their own care and enhance their independence. Despite the overwhelming benefits demonstrated through these trials, many cease when the grant funding concludes. While funded agencies are unable to sustain the programs and realise the substantial benefits, traditional service models remain unchanged and therefore inevitably unviable. Why is this so? There are two fundamental reasons. The first is that pilots are often conducted as standalone systems. As projects have a short-term duration, they do not integrate with the service delivery management systems for the provider agencies; therefore the agency does not make the investment in restructuring
their core businesses to take advantage of productivity improvements. The second is that although some of the benefits are achieved by the community care agency, there is generally a misalignment between the receiver of the benefit (i.e. the hospital, the nursing home through reduced admissions or the community at large) and the agency that has to bear the cost of equipment provision, solution integration and process re-design.
Sustainable models required What is required is a mechanism for agencies to be subsidised for the telehealth investments they make that result in benefits for other health providers and broader segments of the community. In primary care, the federal government has responded by providing MBS funding for telehealth consultations between general practitioners and specialists. The response in community care has been less supportive. Agencies are now permitted to use a portion of a client’s funding package towards telehealth services. However, the average spend per year for Home and Community Care-funded clients is around $1700; the average Community Aged Care Package provides around $7000 per client annually. Community telehealth solutions need to be designed for use by people with low technical acuity. Many products on
the general market require expertise in internet, iPads or mobile phones, which may be unsuitable for an elderly person with dementia. Solutions are required that take advantage of these technology developments, but are packaged and delivered so as to reduce the requirement for training and on-site support. A solution incorporating videoconferencing, monitoring devices, network and support may range from $1200 to $2500 per year per client (based on a three-year costing model), which makes it difficult for agencies to build them into affordable service delivery models while continuing to meet other essential care needs. If governments are really serious about slowing the unsustainable growth in the cost of healthcare in Australia, reducing hospital and nursing home admissions, responding to community preference to be cared for at home, and improving service efficiencies, then community care providers have an important role to play. New funding models need to be created that incentivise investment in innovative solutions and pass back some of the benefit that is gained by the broader community from the provision of telehealth services to the provider agencies. Some important telehealth pilots are due to be completed by June 30 2014, and the results from these projects will prove useful in substantiating the benefits to the community.
TECHNOLOGY AS A TOOL TO KEEP PEOPLE AT HOME
RDNS has nearly 130 years’ experience in the provision of home healthcare, and its growing range of services reflect the challenges of an ageing population and increased rates of chronic disease. RDNS has taken a leadership role in using technology for the past 20 years to improve access to care in the home as part of this changing aged care environment.
JEFF CARSON B App Sci, MACS CIO, RDNS
Investment in information technology at RDNS is playing a vital part in support of quality healthcare for our clients in their homes, as well as an improved care management experience for families and clients. Technologically, RDNS has always sought to be a leader and take advantage of emerging technologies. Our telehealth activities are linked via the central hub of our Customer Service Centre and our services now comprise the provision of home care across Australia, thus responding to the needs of people who are increasingly wishing to remain in their own homes to receive services. RDNS sees telehealth and telecare as a key aspect of our response to the increasing demand for quality, cost‑effective services. RDNS is essentially developing a technological ecosystem through which required support can be brought to a client in the quickest and most effective manner, without compromising clinical quality or a sense of personal connection.
About the author Jeff Carson is CIO of RDNS. His experience includes senior executive positions at Baptcare and CitiPower, and he is also known for his work on Port of Melbourne projects. Jeff specialises in the application of ICT in support of business transformation, and he sits on the ACIITC CIO steering committee.
Different situations demand different modes of care and with telehealth, this may not always mean home visits only. It may be more appropriate to connect a RDNS nurse with a client through webbased video conferencing, providing the client greater flexibility whilst giving us the ability to provide more care to more people with decreased travel time.
This sort of technology also allows the connection of peripheral devices to remotely monitor various indicators of a client’s health such as heart rate, temperature, glucose levels and body weight, and record these measurements against a client’s care record.
Telehealth and mobile health Our Integrated Telehealth Project is fully subscribed with over 200 clients with chronic conditions receiving a range of services and support to assist them with management of their conditions. The project will run until September this year, with participants in Victoria, NSW and Tasmania using a range of technologies to connect with RDNS nurses and GPs. This project has again demonstrated the acceptability to clients of virtual care as a service model and the reassurance that can be provided to clients via regular contact with a nurse, albeit virtually. It has also highlighted the importance of matching the technology with the client to ensure useability, reliability and cost effectiveness. One of the key questions to be answered out of our telehealth projects has been the one about a sustainable business model. Our project experience has demonstrated that sustainability will be a combination of closely matching the technology solution with the client need and, where possible,
accessing adaptable consumer solutions. In the end, it’s about reliability, clinical safety, ease of use and cost. It is becoming clearer that there is a sustainable business model for virtual delivery of some services which are either direct to the client or provided to staff in supporting them to deliver face-to-face services to clients.
“The RDNS vision is a response to three inconvenient truths: people are living longer, chronic disease is growing and the cost of aged care is stretching public purses.”
For our staff, technology means they will be a truly mobile workforce, able to respond in real time via their mobile tools of trade as information is provided from central intake direct to their device.
For the clients, the benefits are many. Staff have access to all information, which reduces clinical risks. Also, when the nurse is visiting a client at home he or she can access other clinicians remotely for additional assessment. Clients can also have improved understanding and involvement in monitoring their own condition with telehealth and devices left with them. Clients can also get additional training to help their conditions – for example, the RDNS Leg Ulcer Prevention Program – via the education tools loaded on their nurses’ device.
implemented for our home care packages and focuses on consumer choice as the driver and all of our systems and processes have been updated to support this change. Technology plays a major role in supporting the CDC model and associated administrative requirements which include managing individual client budgets, reporting requirements and contract management. Telehealth, assistive technologies and sophisticated IT systems underpin the ongoing transformation to CDC.
Into the future
Consumer-directed care is, in effect, an extension of what we have been doing for many years – listening to the client and delivering what they want. It is really about ‘doing with’ and ‘not doing to’. To support this, we are continually refining and enhancing our IT infrastructure to ensure that we meet our clients’ goals and expectations.
The RDNS vision is a response to three inconvenient truths: people are living longer, chronic disease is growing and the cost of aged care is stretching public purses. These are also global realities. China has just passed a sobering statistical milestone – 200 million people over the age of 60, or 14 per cent of the population.
We are in an era where we must be efficient and smart to ensure that clients get the most value as well as the best services and support. RDNS has been at the forefront of technology for more than 20 years so we are very well set up for the CDC model using tablets, smart phones, apps and other technologies. The consumer-directed care model hasbeen
Domestic and overseas interest in RDNS has grown and diversification has become a key element in our business planning, which is one reason our recent joint venture with Zhongshan College in China came about. There is a need in China for the sort of expertise and experience RDNS has and we are responding to that need. The issue of ageing and solutions to ageing
is a shared responsibility and we take that responsibility seriously in an age of globalisation. Here in Australia, multiple factors are combining to increase the number of people aged over 65. By 2028, for the first time in our history, there will be more people aged over 60 than aged under 20. RDNS has not just a long history in helping people to age in place, but a very significant capability to respond to what lies ahead. We can help to meet these challenges, in large part by keeping abreast of new technology and working with providers to ensure that our staff have the latest and most appropriate devices and that RDNS remains a home healthcare leader in technology. It means continuing to be innovative and responsive. Ultimately, our focus is always and always has been on improving things for our clients, their families and by extension those we partner with to deliver services. The tools that IT provides have to deliver better outcomes to clients first, whilst at the same time assisting us to do things more efficiently and effectively. IT has and must continue to play a major role in defining RDNS’ quality whilst differentiating us from other providers and improving choice and quality of life for those we support.
AGEING AT HOME: ICT AND SENIORS’ LIVING The 7th annual Information Technology in Aged Care (ITAC) conference is being held in Hobart in July. As the role of technology in helping people to stay at home longer continues to grow in importance, this year’s conference theme of the ‘digital revolution in seniors’ living’ is a fitting one. Emphasis will be placed not just on gadgets and the potential of telehealth, but on developing sustainable models of service provision in community and residential aged care.
KATE MCDONALD Journalist: Pulse+IT email@example.com
As this issue of Pulse+IT shows, the use of technology in aged care is no longer restricted simply to the use of clinical management systems in residential aged care, or of monitoring systems or telehealth in home care. It now runs the full gamut of technologies that can support the care of elderly people in their homes, their communities, the primary care sector, the hospital sector and the residential aged care sector. As several of our contributors have pointed out, it is not so much the use of technology that poses a challenge in aged care, or the development of new technologies geared towards elderly people. These days, the challenge is very much about how to develop sustainable business models to encourage initial investment in technology and ongoing funding for the provision of care to the elderly in what will remain a predominantly publicly funded sector for the foreseeable future.
About the author Kate McDonald is a senior staff journalist for Pulse+IT. Formerly the editor of Australian Life Scientist magazine, she has also edited industry titles Hospital & AgedCare and Nursing Review. Her interests cover health ICT, biotechnology and translational research.
As assistive technologies continue to develop – and to come down in price – more of the nitty gritty of service provision through these technologies is coming to the fore. The ITAC 2014 theme of “assistive technologies: disruptor or enhancer of services?” is therefore a pertinent one. The afternoon session of day one of the conference will hear an update from the
Aged Care Industry IT Council (ACIITC), which earlier this year released a report calling on the government to invest $10 million as seed money to assist the industry to begin to catch up with the investment made in the primary care sector, particularly to GPs and pharmacists. What the council’s aged care ICT vision calls for is an emphasis not just on proven technologies like telehealth or emerging technologies like the PCEHR, but on the more mundane but very much critical areas of integration of care planning, management information and reporting, and staff productivity.
IT vendors Technology conferences are used to seeing IT vendors spruik their wares, but at ITAC this year, the Aged Care Industry Vendors Association (ACIVA) will discuss the role of vendors as partners in delivering care. ACIVA president David Loiterton, who took over the role from long-term president Caroline Lee last December, will discuss the view of vendors that it is imperative they play a connected role with providers, the government and other regulatory bodies. “We need to be proactive in contributing to and helping shape technology policy, as well as interacting
with the various departments to stay ahead of the changing landscape in the aged care sector,” Mr Loiterton says. “We all understand the complexity of attempting much of this individually and with disparate goals.” He says ACIVA members face a number of challenges in serving their clients, not the least of which is navigating the new government’s departmental structure, and trying to manage continual changes to regulations through policies such as consumer-directed care and Living Longer Living Better. “There continues to be poor communication and interaction with vendors in a timely manner, to allow for
melbourne 11 - 14 august
changes to be made and ‘appropriately’ tested,” he says. “ACIVA will seek to work with the peak bodies and government to ensure these changes are more transparent to vendors at an earlier stage.”
Telstra Health The topic of mobile technology in the home and in residential aged care facilities is on the agenda, as is IT governance risk management, and medications management. Former Victorian minister for aged care, Bronwyn Pike, who is now working with Telstra as a community care lead, will discuss Telstra Health’s ambitious plans in the aged and community care sectors.
Preliminary results from some of the NBN-enabled pilot projects will be revealed, including from the CSIRO’s multi-site national trial of telehealth for the management of chronic disease in the home, and the South Australian telehealth project that is trialling the remote provision of palliative care, aged care and rehabilitation therapies. There will also be a PCEHR session, with Feros Care’s Kate Swanton discussing the justification for and journey with the PCEHR at Feros Care’s facilities. And social media will make an appearance, with Stuart Couchman of Azzurri Communications discussing how social media can be used to improve client and guest experience in aged care.
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THE MISSING LINK FOR AGED CARE The Aged Care Industry Information Technology Council (ACIITC) has called on the government to invest $10 million as a starting point to get wider IT adoption moving in the sector, which has experienced slow uptake of technologies besides clinical care software. It also believes financial incentives are necessary for providers to become PCEHR-ready, with the absence of key software functionalities playing a large part in the sector’s slow pace of change.
KATE MCDONALD Journalist: Pulse+IT firstname.lastname@example.org
In March this year, the Aged Care Industry Information Technology Council (ACIITC) – an umbrella group representing the two main aged care associations, LASA and ACSA – launched what it calls its “vision” for IT in aged care, asking for a one-off investment of $10 million to help the sector implement a plan for better ICT services and new models of care. The council argues that the investment of $10 million should be looked at as seed money to enable aged care providers to begin investing more in ICT, similar to previous investments made in the primary care sector for GPs and pharmacists. And in a nod to the Coalition government and its stated agenda of cutting red tape and freeing up business investment, the blueprint argues that the government might also take the opportunity to review the scope of information currently required by streamlining reporting requirements and information access. ACIITC chair Suri Ramanathan says that while the industry has put forward a firm figure of $10m, it well understood that the current focus is on tightening budgets rather than expanding them. However, the aged care industry is arguing that in addition to the investment, the government and the industry can together look at reducing waste.
That said, the purpose behind the blueprint is to argue that investing in ICT is a way to change models of care to better enable older Australians to remain independent and well. “The reality is, this entire discussion is all about how you change the models of care,” Mr Ramanathan says. “It is about how you enable and maintain the dignity of older Australians. Right now, I think that technology has gone way beyond the policy.” The Digital Care Services: Harnessing ICT to create sustainable aged care services blueprint, developed in association with Accenture, does look at different areas such as telehealth, eHealth and the PCEHR, but also at less headlinegarnering topics as integration of care planning, management information and reporting, and staff productivity. It argues that leading providers are looking to improve the productivity of their workforce by reducing the administration and travel burden, maximising face-toface care time, and providing unobtrusive monitoring or assistance when carers cannot be there. What the aged care industry is looking for is stable investment and a move beyond the ad hoc projects announced and funded in the past with little follow-up or coordination. “What we would like is
some normality,” Mr Ramanathan says. “We don’t really need people to tell us what to do because we pretty much know how to look after older people, and to be very honest the people who we look after actually know what they want. “That may come as a surprise to a whole lot of people, but our clients know what they want and we want to work with them. What this vision is all about is the industry doing something in terms of leadership. What we’re saying is this is our canvas, it is not prescriptive about what should happen, but that eventually we’d like to liberate the consumer to become a participant in their care, not just be recipients of care. They take ownership of themselves and we will then help and enable them.” Mr Ramanathan says there are three audiences that ACIITC and the peak bodies are targeting with the vision: the first two being the government, which funds the industry, and the bureaucracy, which administers it. The third audience is the providers themselves, he says. “Some of them need to look at ICT and how it can help address their workforce issues, and their need to be sustainable and viable. They should look at ICT as a way to make themselves viable so they can provide care the way our clients want it.” However, one of the often forgotten groups when looking at ICT in aged care is the nurses and carers themselves. Industry figures show that IT literacy among care staff is less than 50 per cent. Nurses already have heavy workloads, and require IT solutions that work with them rather than against them, Mr Ramanathan says. “This is a nurse-dominated environment. Basically, the ICT vision talks about very simple things before talking about electronic medication management and all of more complex stuff, which we are more
“Eventually we’d like to liberate the consumer to become a participant in their care, not just be recipients of care.” Suri Ramanathan
than competent to do anyway. You have to look at it in context. These nurses, who work so hard, for them to have confusing systems is the last thing you’d want.”
Aged care and eHealth
Mr Ramanathan says once discharge summaries are seamlessly integrated with aged care clinical management software, “our people will move. But they need a clear signal that there’s financial support for the change to take place. That’s the missing link.”
The aged care sector is also calling for financial assistance to help it roll out the PCEHR and other eHealth initiatives. While the initial focus of the previous government was getting primary care PCEHR-ready and there has been some work done on hooking up acute care, aged care – where the concept of a PCEHR is very well supported – seems to have missed out.
HI Service integration, CDA document uploads and downloads and shared health summaries are all working well in aged care, and there now needs to be a focus on eReferrals, discharge summaries, integration with the National Prescription and Dispense Repository (NPDR) and secure messaging.
Mr Ramanathan says eHealth measures such as electronic discharge summaries would be a boost to wider uptake of IT in the aged care sector, but financial support was also needed.
Mr Ramanathan estimates that the foundational work will take another year to finish, but the industry’s successful integration with the PCEHR system will still be a five- to 10-year process.
“For a pharmacist to push the enter button at the pharmacy, they receive a PBS dispense fee,” he says. “In terms of the GPs, they have come up with two ePIPs to ensure the GPs come on board with PCEHR and the elements of eHealth.
The council believes that organisations need to act now to ensure their software providers sense a market stimulus to move on making their products PCEHRready and that the solutions they delivered are based on NEHTA standards, but Mr Ramanathan acknowledges that without an economic stimulus for change, industry lacks real impetus to pursue it.
“[But] we are much larger than both combined. Aged care is one of the largest industries in the country. We have 300,000 FTE employees. Facilities operate on a paper-thin margin, so for them to adopt change, they need a little bit of a hand, for the same reasons that exist for pharmacies and GPs.”
“The message to providers is that PCEHR is a vital tool to get information to mitigate risk in aged care, but we are looking for that moment when there is policy support to adopt it.”
AN IT APPROACH TO GP CARE Paper-based systems are no longer enough when it comes to the collaborative care required when caring for patients in residential aged care. GPs working in these settings should take a strategic view of their IT requirements â€“ whether using remote access, cloud services or interacting with the facilityâ€™s clinical systems.
DR HENRY KONOPNICKI MB BS (Hons), FRCPA, MBA, BSc General practitioner email@example.com
Contemporary primary healthcare in residential aged care facility (RACF) settings needs to be collaborative. For GP involvement to be effective, it needs to address the holistic biopsychosocial model. The ageing process involves multiple pathological pathways needing a range of health professional inputs. Therefore, rather than a reactive process, a more proactive approach is needed to support and manage physical and psychological decline. This requires multiple modalities of medical interaction resulting in a range of outputs, from consultation notes to comprehensive assessments incorporating a multitude of inputs and observations. This is further compounded by the setting being at a distant point of contact from the classic consulting room.
About the author
In order to address such an approach, the GP needs to stand aside and take a strategic view in formulating an appropriate solution to address these needs and information flows.
Dr Henry Konopnicki is a GP with a background in clinical chemistry. He is currently a member of a committee assessing use of antipsychotics in dementia. His main focus is aged care and communitybased practice utilising smart technology incorporating real-time communication with health providers, patients and their families.
Considerations need to take into account information inflows, timely access to data, the ability to record and transfer information, and the production of documentation of value to a range of stakeholders in the RACF setting.
In the context of service provision, general practice needs to consider whether hosting extensive IT infrastructure is a core activity. A paper-based solution will not be able to deliver the needed outcomes, so a digital system encompassing electronic inflows needs to be considered.
Modes of electronic access and storage In terms of system components, GPs active in providing care in RACFs need to consider the primary storage of data for real-time access. There are several modes of electronic access that GPs can look at. 1. Practice server with remote access In this model, considerations should include: IT support and access; timeliness of response; software updates, security and maintenance; back-up strategies and interruption to services. 2. Cloud-based solutions Considerations when using a cloud model include: integrity and business sustainability of provider; terms of service, ownership and access of data; support, back-up and service interruption; virtualisation and redundancy. Cloud providers also need to have niche experience and understand the needs of a medical model and timely access.
This form of access is be further enhanced by the introduction of virtual server access within Australian jurisdictions by a number of providers such as Microsoft, providing mirroring and redundancy with physically remote sites. 3. Medical software hosted at RACF Considerations include: ownership of data; responsibility for maintenance and updates; and access to facility hardware and systems. A major consequence of this solution is the clinical database is now not consolidated.
“The GP needs to stand aside and take a strategic view in formulating an appropriate solution to address these needs and information flows.” Dr Henry Konopnicki
For the management of information flow, accessing incoming documents and incorporation into the clinical system, considerations include:
redundancy, thereby minimising loss of access • Embedded real-time digital document systems for document storage and retrieval independent of patient-based queries • Potential ongoing development addressing specific requirements.
• Current privacy requirements regarding storage and retrieval • Electronic transfers using messaging services such as Argus and Healthlink • Acquiring faxed documents as PDFs via secure email in real time • Physically scanning documents at point of contact directly to virtual or remote desktops in real time • Scanning to local client and subsequent transfer.
The above are the basic components of the service at a distance and associated considerations. The clinical software can be enhanced by associated clinical guidance software incorporating streamlined information procurement aiding generation of quality documents and assessments. As a specific example, such software can aid monitoring and use of antipsychotics in dementia, addressing a current clinical controversy.
In terms of printing with remote access or cloud access, consideration needs to be given to redirectional software to local printers at the point of contact.
Associated clinical utilities such as MIMS need to be subscribed to as web-based services to allow online real-time clinical queries at the point of clinical interaction.
Choice of primary clinical software
Some clinical guidance software incorporates subscription web-based services.
Management of information flow
Considerations include: • Ability to function in remote access mode • Ability to function in a virtual environment • Ability to adapt to web-based services and take advantage of mirroring and
should point out the advantages to the facility, such as: • • • • •
Full and extensive clinical notes Comprehensive documents Detailed real-time health assessments Detailed medical medication reviews Regular updated summary of medical care • Detailed notes of case conferencing. All of the above documentation aides improve clinical care as well as supporting the RACF’s funding claims. Currently these activities are MBS claimable items. With access to the facility software, examination notes are just a matter of cut and paste. For documents it is a simple matter of generating a document copy and sending it to the facility software, usually via file upload.
Hardware requirements range from accessing the RACF’s PC and broadband, which is ideal, to the GP providing a tablet or laptop with wireless internet access.
We now have to consider how the systems interact with facility-based software. With cloud-based and practice server-remote access systems, it is vital for the GP to discuss their needs with the facility. GPs
To enhance clinical utility, consider the use of a laptop or tablet with 4G access to enable real-time clinical review at the bedside. Further, with some operating systems, you can capture real-time patient
interactions such as writing capacity within mini mental assessments which can be captured as uploadable images or documents into clinical software.
construction allows pharmacists restricted access to only those patients they supply medication for.
Other applications allow audio capture which is also uploadable both to GP clinical software as well as RACF software.
This can be further restricted to viewing only the medication listings. The pharmacist is then able to set up scripts required but not to print.
This together with inbuilt photography allows for more meaningful longitudinal monitoring of clinical progress. The above assumes appropriate informed consent has been obtained.
These are stored in a holding file for the GP to view and print. Remember to compare this to web-based systems offered by some pharmacy services. Once again, the clinical record is no longer consolidated.
Some facilities have facility-wide wireless systems, which allows all the above including transfer to facility systems to be done at the point of consult, including room-based consults.
Remote access lends itself to telehealth via multiple hardware platforms ranging from desktops to mini tablets. With remote access, notes and investigation results can be viewed by both parties during the consult.
Interactions with other health professionals Further issues to be considered include the production of prescriptions. Some clinical software with the appropriate database
A further issue in aged care is the ongoing communication between the GP and medical power of attorney (EMPOA) to exchange and inform families of clinical progress and issues.
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This has now been addressed by a model utilising a secure mail client to allow access by EMPOA of clinical notes, assessments and investigation results.
Conclusion GP involvement in residential aged care needs to be focused on collaborative care. This requires the appropriate information gathering and dissemination processes as outlined. The GP is in a unique situation in this setting and with the appropriate strategic vision and digital tools, can positively impact the quality of residential aged care. Further, these systems continue to evolve, requiring ongoing review and adaption. Such systems can be extended to all virtual consults and allow the GP to practice in multiple settings, meeting a wide range of clinical requirements and breaking the tyranny of a physical-based practice setting.
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SOFTWARE AS A SOLUTION TO RISK MANAGEMENT Residential aged care faces numerous challenges, not the least of which are tight budgets, a casualised workforce and skill shortages. When added to the demands on staff that the volume of mandatory documentation places, the potential clinical risk is high. Software that is customisable and alerts staff to potential risks is one way that aged care managers can more effectively manage risk.
DAMIEN MALONE BN, BA, MBA, M Nursing Facility manager/DON, SomerCare firstname.lastname@example.org
The aged care industry has had many challenges to face in recent times, including changes in funding putting additional strains on business models, an ageing workforce set in the background of skill shortages for new employees, increased casualisation of the workforce, and an agenda aimed at keeping people at home in the community longer. This means residential aged care is seeing an increase in dependency of new residents, shorter lengths of stay and increased resident turnover. Combined, this has had a significant effect on day-today workloads and has created challenges in the area of risk management for residential aged care facilities.
About the author
Risk management is an important consideration for any manager responsible for the provision of residential or community aged care services. Clinical risk can be defined as a situation in which an action or inaction on the part of an organisation results in a potential or actual adverse health effect on the consumers of a health service.
Damien Malone is facility manager and director of nursing at SomerCare, a 100-bed aged care resort on the Mornington Peninsula in Victoria. He is also a member of the Health Informatics Society of Australia’s aged care special interest group (SIG).
Whilst there will always be a requirement for the expertise of quality clinically skilled staff in assessing and managing clinical risk, it is important for organisations to look for creative ways to support the identification and management of risk.
Many aged care facilities have embraced electronic resident systems as a tool to improve quality of documentation and to support funding claims, but in my opinion there should be serious consideration given to the importance of clinical risk management features of any software purchase made in residential care. Facilities are collecting large amounts of data through personal information gathering, clinical assessments, observations, incident reporting and feedback systems. Reflecting workforce changes, this information is gathered by a variety of staff with significantly different skills and knowledge, which can affect timely interpretation and analysis of data. This creates a risk of “siloing” of information until auditing or review processes can identify links or make interpretations of information. This article will focus on some of the aspects of risk management provided by the SARAH residential software package, which we use to help manage risk within our organisation. Several other software packages also carry some of these features, so consult your vendor.
Risk management tools SARAH residential software is an allof-business software solution which
“In my opinion there should be serious consideration given to the importance of clinical risk management features of any software purchase made in residential care.” Damien Malone
provides resident, employee, maintenance, document control, quality, supplier and financial management systems for an organisation. One of the key features of the software is its integration between various areas, making it easy to trace systems and processes. SARAH has spent a lot of time and effort working with clinical staff and managers to develop risk management tools which support the clinical expert to identify real-time risks. It does this in a number of ways. Clinical observations are one area addressed under the system. All residents have a doctor’s order form completed, which identifies any observation areas that are required to be monitored and allows the general practitioner to identify normal ranges for that individual. When a staff member completes an observation (often a personal carer) and enters it in the system, it generates an on-screen alert for the staff member if the observation falls outside of the normal range – reinforcing the need to escalate it to the registered nurse. Simultaneously, the system generates an alert for the RN, EEN, clinical coordinator or any other staff member the organisation deems appropriate to alert as it is fully customisable. The alert needs to be
actioned by that person, thus ensuring a trail is created to identify strategies to manage these risks.
Tracking movements Two areas of significant clinical risk within an aged care facility relate to bowels – these are constipation and gastroenteritis. SARAH has an in-built alert system to highlight to the clinician if a resident has not had a bowel entry recorded (or no record of bowel motion) for a defined period of time. This is also customisable to each facility’s individual policy and removes the need for someone to regularly go through bowel charts counting days since use and recording it on handover sheets. The program also monitors bowel charts across the organisation and generates an alert if two or more residents are marked as having watery stools. This again gives the skilled clinician information which will enable them to assess if a potential outbreak is imminent. Historically, this information may not have been easily identifiable if the two residents reside in different areas of the facility overseen by different staff. Weight loss is another indicator of risk within residential aged care. Ongoing monitoring and auditing of residents’
weight has been a regular process in most facilities’ risk management systems. In SARAH, the parameters can be set to auto generate an alert based on the loss of an actual kilogram amount (ie 2kg) per period or a percentage of weight lost alert (ie 2%). Again, these alerts are instantaneous for the person entering the result, promoting reporting to senior clinicians but also creating an actionable alert for both clinicians and the dietician which need to be addressed.
Visiting doctors General practitioners visit facilities regularly throughout the week and may encounter many different staff when onsite. One concern often mentioned by GPs is the failure of staff to follow up on their requests, particularly when the staff member they see is not rostered for a number of days. SARAH allows GPs to select a follow-up required alert when making an entry in the system, which again generates an automatic alert for the registered nurse or clinical manager to indicate that some action is required from the visit. The alert remains current until such time as a staff member actions the request. Incident analysis is another important component of risk management. Many of us who have been in aged care for a significant time recall the hours of entering clinical information into tables to generate graphs to assist in the analysis of incident trends. Utilising an electronic system such as SARAH allows instantaneous real-time analysis and charting of incidents. SARAH goes one step further in allowing easy manipulation of analysis to allow you to drill down easily by dragging options around the graph so that factors such as time, contributing factors, or individual residents involved can be considered at
the click of a button. A process which previously could take up to half a day now can be done within minutes and easily within a clinical meeting or review group, allowing for improved and more timely analysis.
Reporting requirements Compulsory reporting is another area of risk that relies on significant knowledge by staff and strong systems in place to ensure tight time frames can be met. SARAH incorporates a reportable events system which can be associated to certain incident types such as aggression. When a staff member puts in an incident form, the system automatically carries data to the
compulsory reporting system and alerts the staff member entering it that it falls into this category. Simultaneously, the system sends an automatically generated message via email or SMS to the nominated manager to alert them of the potential risk to allow swift follow-up and early management of the event, reducing the risk of non-compliance with legislative requirements. Whilst these are only some of the many risk management features of the software, they serve to highlight the way IT can be used to support clinicians and to allow management a clearer understanding of risk within the organisation.
HealthLink now puts referrers in the picture
Using a system that is customisable to facility policy and procedures and which to a degree removes or spreads the human element of risk management automatically to many key people within an organisation in itself allows for a reduction in the potential effect of risk on the organisation. Organisations reviewing or considering a software suite should be asking questions of providers as to how they can assist in the management and reduction of risk. We have moved past the era of the electronic system as a glorified word processor to a time when they can have a significant effect on overall business management and can help overcome the challenges the aged care sector faces.
Referrers can now see images from the patient record HealthLink already delivers tens of thousands of diagnostic reports every day. Now in conjunction with Medinexus, referrers can access reports and images directly from their clinical system or via a web portal - no matter where they are. In association with
Tel: 1300 79 69 59 Email: help@ medinexus.com.au Suite 1102, 1 Newland Street, Bondi Junction NSW 2022
“We attract more referrers by delivering our reports and images via the HealthLink and Medinexus system” Radiologist, Liverpool NSW
“One of the great things with HealthLink and Medinexus is that when the radiologist calls me regarding an abnormal finding I already have the images and reports available on my screen ‘straight away’ so I can see exactly what he is referring to” Referrer, Pennant Hills NSW
“It’s so simple to use. There’s no longer any need for film or a hard copy report to be delivered to me. It’s also so convenient that I can access reports and images no matter where I am” Referrer, Sydney City
WIDESPREAD WIFI ALLOWS AGED CARE TO CONNECT As a smaller aged care provider, Queensland-based Feros Care has invested heavily in technology to not only bridge the distance between its facilities and its staff, but to improve the care and the experience of older people. The organisation also provides community care packages in which it is trialling the use of telehealth and tablet PCs, and runs a thriving private home monitoring service for older people called Lifelink.
KATE MCDONALD Journalist: Pulse+IT email@example.com
In 2013, Feros Care upgraded all of its residential aged care villages to the next generation WiFi standard, 802.11ac, which will allow the organisation to provide highdefinition video conferencing and VoIP phones to every bedside and to further develop its telehealth capability. Having been one of the first to install a WiFi nurse call system at its Byron Bay facility in 2011, Feros Care will use the new Gigabit WiFi 802.11ac technology from Aruba to install WiFi nurse call throughout the organisation’s facilities. It will use the upgrade to provide video conferencing to the bedside using custombuilt touchscreen robots, deliver clinical care systems to the bedside, provide internet access to residents and guests, use RFID tracking for assets, and replace its DECT phone system. It also plans to introduce new services for residents such as virtual museum tours and online bingo. Feros Care’s CIO, Glenn Payne, says one of the benefits of WiFi is that it allows the organisation to be more flexible and versatile with room set-ups to cater for the individual needs of each resident. “Our goal is to transform our facilities into ‘Smartvillages’ and we love the idea
of not relying on the wiring in the walls to determine the technology we use in the rooms,” Mr Payne says. “We have the opportunity to install and remove items as the resident needs change. With the help of a partner, Surecom, we heat-mapped each site to enable ultimate coverage as the scope was to enable and prioritise voice and HD video throughout each site.” VoIP and WiFi internet will allow residents to use cloud-based products like Skype, Facebook and Google+ to keep in touch with their families in the comfort of their own rooms, and Feros Care will offer “silver surfer” training to get the residents on-board and using these technologies to connect. Feros Care also plans to provide virtual tours for less mobile residents through live streaming of museum tours and cultural events. Mr Payne is currently investigating the use of camera technology similar to a GoPro and microphones to enable two-way interactions at special events. Feros Care also wants to connect its residential sites with virtual games like bingo and trivia using high definition video and multiparty rooms. “It’s a way to use gamification and get sites excited about connecting with each other socially using
technology, and at the same time having a little fun,” he says.
Staff connections In 2012, Feros Care purchased seven LifeSize room-based systems and a LifeSize Passport device, which allows users to make point to point video conferences from anywhere. It also bought 100 licences to LifeSize’s ClearSee system, which lets remote staff to dial into the room-based units from their laptops or mobile devices.
“We heat-mapped each site to enable ultimate coverage as the scope was to enable and prioritise voice and HD video throughout each site.” Glenn Payne
Before introducing video conferencing, Feros Care was trying to run a centralised business without using centralised collaborative tools.
“What that means for Feros Care was that we weren’t getting that communication out to staff. They were very isolated out there and they weren’t feeling a part of the organisation.”
“We would spend a lot of time hiring venues and going to meetings as we don’t have a traditional office structure,” Mr Payne says. “We only have six offices and we have a lot of staff who work from home.
Sixteen months later, Mr Payne says the use of video conferencing has changed pretty much everything Feros Care does in terms of procedures and processes. The company had estimated it would need to
be doing 18 site-to-site conferences every month – which have an average cost of $403.22 – to achieve its forecast return on investment, but staff have taken to the technology so well that they are doing about 60 site-to-site VCs a month. “What that doesn’t include is our desktopto-desktop VCs,” he says. “We have now just about chalked up 7000 desktop-todesktop video conferences, and it has
changed the way we work. “It is now being adapted into our everyday business. With our staff, there is a new word now that we use which is ClearSee, as in ‘I’ll ClearSee you’. There is a whole new language that is coming out with this. “We’ve also got some new business down in Tasmania because of the NBN. As we don’t have a care manager in Tasmania, we are actually running a care manager from Victoria all via video conferencing and that wouldn’t have been possible for us 12 months ago.”
Telehealth Feros Care has long been interested in the potential of telehealth, particularly as the company provides home and community
care as well as residential aged care. It has launched a three-year pilot program called TEMCAS using video conferencing with GPs and specialists for residents with complex health needs. Added to the new WiFi capability, the technology will allow virtual consultations between residents and their health professionals anywhere within Feros Care’s facilities. It will also improve privacy and convenience for residents, particularly if they are very frail or ill and are unable to get out of bed. Mr Payne says the WiFi technology will support virtual education sessions, group allied health programs and case coordination across its three residential villages. The company has also invested
in custom-built video conferencing touchscreen robots that can be wheeled around the villages using the gigabyte WiFi network. Feros Care is also running a telehealth pilot project called My Health Clinic at Home (MHCAH) for older people living at home in the town of Coffs Harbour in NSW. The idea is to showcase the benefits of high speed broadband and to get an independent evaluation of the viability of the service. Mr Payne says that although the report will not be published until later in the year, “it is safe to say that the pilot has opened Feros Care’s eyes to what is possible”. The $2.8 million MHCAH project is looking at new ways to use the NBN in healthcare.
It involves using a touchscreen device with in-built video camera and peripheral devices to monitor health and wellness at home. The trial includes in-home monitoring of vital signs and general wellness, self-management education about health conditions and in-home video conferencing with doctors, nurses and friends and family. Mr Payne says there are now over 100 tablets in people’s homes that are being managed by one telehealth nurse situated in Coolangatta. “Every day we have interaction with these clients and they seem to love it. A lot of these people are home ridden and can’t get out so it helps with the social isolation. “Our goal from the pilot is to develop up a cost model and include the My Health Clinic at Home technology as a standard service option for Feros Care in all areas as a part of our home care package services. “[That] allows for technology to be included as service options within the consumerdirected care model. So this will allow Feros Care to consider this service anywhere in our footprint, not just Coffs Harbour.” Feros Care had also been given initial notification of a successful tender to commence operation of MHCAH in Sydney’s south, where Feros Care runs a service under the Home and Community Care Program. It is also looking at self-funding a pilot with its Tasmanian clients later in the year, using the MHCAH technology as a standard part of Feros Care’s case management model. “That is providing our package care clients with the standard MHCAH tablet to allow for virtual case management of our clients in conjunction with traditional face-to-face case management visits,” Mr Payne says. “The goal is to connect with clients more often, to improve the efficiencies around
“That is providing our package care clients with the standard MHCAH tablet to allow for virtual case management of our clients in conjunction with traditional face-to-face case management visits.” Glenn Payne
travel, and to give the client the ability to connect virtually with friends, families, GPs, clinicians and other stakeholders in their lives.”
PCEHR and home telecare Another benefit of the WiFi roll-out will be allowing residents who have registered for a PCEHR to access their record easily. Feros Care has worked with its clinical software provider, DCA Health’s The Care Manager (TCM), to roll out the PCEHR in its facilities, one of the first in the country to do so. Feros Care piloted the TCM interface with the PCEHR in June 2013, and successfully connected in July. Mr Payne says this technology has enabled community care managers to make clinical decisions about clients’ wellbeing through read-only access to the PCEHR. “This is the future of health and clinical decision making and Feros were very proud to be one of the first aged care companies to connect.” Feros Care is currently working with Medicare Locals to significantly increase the number of its clients and residents registered for a PCEHR. “We are particularly excited about more hospitals coming on board to provide hospital discharge summaries and for our clients being able to include their own advanced care directives on their eHealth record.”
In addition to providing residential and community care, Feros Care also runs a thriving home monitoring subsidiary called Lifelink, which supplies telecare products and services to people living at home. The organisation recently installed its onethousandth Smart Home with its range of telecare and telehealth products. The Lifelink team includes technicians, nurses and other care professionals who are able to offer advice and solutions to clients and families on what technology can support their ability to remain living independently. This includes emergency pendants, falls detectors, auto lighting, bed and chair sensors, medication reminders and environmental sensors for smoke and gas for people living with dementia. Feros Care has also been trialling GPSenabled smart watches for residents and clients. Mr Payne says that while he’s not in a position to recommend any product, he is pretty excited about their potential. “Waterproofing and size are our two requirements we are searching for at the moment, but we will keep trialling as they will provide a huge peace of mind for families who may have a loved one who wanders or may get confused or lost at times. This type of technology may allow some seniors to remain living in their home for longer and it’s our priority at present to find the right solution.”
COSTS AND BENEFITS OF IT IN AGED CARE Lynden Aged Care in Melbourne’s Camberwell has been an early adopter of IT systems for resident care and staff convenience, and it is particularly pleased with its investment in a full medications management system. Visiting GPs use its clinical system when on the premises as the organisation has gone paperless, but a full venture into the PCEHR will have to wait until all GPs are on board.
KATE MCDONALD Journalist: Pulse+IT firstname.lastname@example.org
As a standalone, community-controlled aged care provider, Lynden Aged Care is as aware as any that investing in IT systems must have both a clinical and an organisational benefit. With a personally involved board and a CEO with a keen interest in IT, the organisation has made some targeted investments in IT that makes it better equipped than most in the sector. The facility has licences for 30 low care beds, 30 high care beds and 20 extra service places, and is currently undergoing a major capital development project that will add a new wing and accommodate 22 more people with high care needs. In addition, it has recently finished building six two-bedroom independent living units. It has gone fully wireless and has made significant investments in the iCareHealth clinical management system, iCareHealth’s medications management system, and the Vocera communications and nurse call platform. It also has an electronic time and attendance system for staff that allows them to simply scan their fingerprint when arriving at work, doing away with the need for paper timesheets, and staff can also log on remotely to apply for leave or make themselves available for shifts.
For CEO Ann Turnbull, the driving force behind the investments was the benefit she could see from the medications management system. “I saw that at a conference and it was clear to me how much time we would save and how it would almost eliminate medication errors,” Ms Turnbull says. “Just to set that up was the expensive part because we had to go fully wireless. For that to work properly is where the investment came in, but once you are already wireless the add-on bits aren’t anywhere near so much.” It was a substantial investment – half a million dollars all up including the infrastructure, Vocera and medications management – but when taking into account the convenience for nurses of the Vocera devices and the time saved on medication rounds, the return on investment is clear, she says. “Nursing staff just carry one device with them in which they can make and receive phone calls, they can receive nurse calls on it, they can talk to the residents, they can locate each other. “There are no telephones and they don’t have to carry a pager or any of that sort of thing, just the Vocera.
“By the time a person comes in to aged care, they’ve got their GP, they’ve got their relationship with the doctor and if he or she is into the PCEHR, then it will come along without any problems.” Ann Turnbull
“With the medications management system, the main benefit is that the nurses have saved at least an hour every medication round. It has almost eliminated medication errors – that wasn’t a major issue for us but it’s still something you don’t want to have.
an electronic clinical or documentation management system, Lynden Aged Care is one of the leaders in the field, particularly with its paperless philosophy. Asked why other aged care providers do not take the plunge, Ms Turnbull says it’s usually the cost.
“And because the staff really found the benefit from the medication management and the Vocera, they have embraced every other system introduction because they’re not scared of it.”
“I would imagine that it is because if you tell them it’s half a million dollars, they would flip out. But the cost benefit is just enormous. We have quite a few staff here who work at other aged care facilities as well and without exception they come back and say this is such a great place to work because it is so easy. They see the benefit so they embrace the other changes that you are bringing in.”
Wireless and paperless Ms Turnbull says it helps to have a very involved board that supports investing in IT. “One of the real benefits of a place like ours is that most of the board members have got now or have had a family member living here, so they know what’s good and they could see the benefits of the medication management system and the Vocera system,” she says. “Their view was that this is why we make money – it is to spend it on residents, not to go into people’s pockets – and they could see very clearly the benefits to the residents.” With some figures showing that up to half of aged care facilities don’t even have
Doctors must drive PCEHR Participating in the PCEHR, however, is another matter. Lynden Aged Care has long seen the benefits of sharing information with other clinicians and providers, and participated in an early shared health record project established by the Inner East Melbourne Medicare Local and its predecessor, but the national system has proved difficult. The main issue is that it is doctors who have to drive the system, she says, and she is not aware of any visiting GP who are
actively using the PCEHR. As someone who is acutely aware of cost-benefit ratios, the latter is not yet apparent with the PCEHR, Ms Turnbull says. “By the time a person comes in to aged care, they’ve got their GP, they’ve got their relationship with the doctor and if he or she is into the PCEHR, then it will come along without any problems,” she says. “But it has to be done through the doctor. My own doctor doesn’t even have the software to work with the PCEHR so there is no use in me hassling him because it won’t happen. The doctors have got to be set up for it.” Visiting GPs to Lynden Aged Care are all given access to the iCareHealth system when they are on the premises to make notes or changes to medications, and most are more than happy to do so. For the one GP who isn’t, a nurse will type the details into the system and the doctor signs it. “We don’t have any paper so they have to come onto our system,” Ms Turnbull says. “There is no paper for them to write on.” And while iCareHealth is PCEHR-enabled, it is not being used as yet for any resident or by any doctor. Ms Turnbull says the creation of a transfer document in the PCEHR would be very useful, but at the moment there was no benefit to the organisation to drive uptake. “It would be terrific to be able to upload a transfer document and then when they get to hospital for it to be downloaded again, but to have that you’ve really got to have the residents signed up for it and the doctors participating. “The GP who has most residents here is really into IT and she loves it. She’s into telehealth, but I’m not sure whether she is signed up to the PCEHR. There just is not the benefit at the minute for us to drive it.”
PHRS, PORTALS AND APPS:
HEARING THE PATIENT’S VOICE The current medico-legal record provides a snapshot into specific episodes of care for patients, but it does not provide a holistic view of the person’s full health history. Different records can be brought together into one album like the PCEHR, but to truly hear the patient’s voice, we must extend this to include information gathered through emerging technologies such as portals, health apps and personal health records. DR KAREN DAY PhD, FACHI School of Population Health The University of Auckland email@example.com
What is the patient’s voice? How do clinicians know we are hearing this voice? And how do we know we’re responding appropriately, safely, ethically, and effectively? Doctors get six- to 15-minute sound bites into the lives of their patients, and nurses may get a little bit longer, depending on the context, but this only provides a glimpse into the lives of patients rather than a long-term view. What if our healthcare interactions were depicted as a 450-picture album? The official healthcare record contains snapshots of care, much like a photo album contains sets of pictures taken by one or two people. Only a partial story exists for the reader. If an adult uses health services on average about five times a year, multiplied by 65 adult years, then we have an album of around 450 pictures.
About the author Dr Karen Day is a senior lecturer in health informatics at the University of Auckland’s School of Population Health and director of its postgraduate health informatics program. She has a research interest in personal health records and how people who become patients use health information.
These pictures tell short stories about each individual interaction between a person and the health service they use, but the stories are rarely connected. Most commonly, the connection is a referral from one clinician to another. Measurement and feedback create a continuous story of improvement and change for clinicians and patients alike. People like measurements. We measure our body dimensions, the food in recipes,
the shopping we do, the money we earn, our educational progress, our health. Clinicians are taught how to do these measurements systematically and use them to apply interventions to improve the health of our patients. Recording the healthcare conversation – hospitalisations, outpatient consultations, primary care visits – is usually one-sided. Clinicians are required to document the conversation and action plan for medicolegal reasons, but patients are not. This silences their voice. There appears to be a cultural paradox in which we expect clinicians to take notes and patients to memorise what happens in the snapshot episodes of their healthcare experiences.
The quantified self Joining the snapshots in the album of life and health into a single, articulate story is possible but difficult. As clinicians we represent the patient’s voice in our clinical notes and care plans, the documentation of lab test results, diagnostic images, and medication prescriptions. What if we could take these snapshots and expand their reach into the patient’s space? One of the first steps is to let patients hear the clinicians’ voice more clearly by providing access to medical records
about them via a portal and medico-legally approved processes. However, the patient’s voice remains silent unless we lift our gaze to include the ‘quantified self’. The quantified self is a description of the recent movement in which people measure their activities and their body’s responses using sensors, apps and wearable computer devices, amongst other things. People are able to see their own patterns and baseline measurements change. They can develop strategies for prevention and early intervention when the patterns change. As technologist Melanie Swan points out in a 2012 article in the Journal of Personalized Medicine1, this could radically change how people use health services, resulting in a more competent patient voice and more coherence of the patient’s story in the health record. Portals give patients license to view their 450 health snapshot album. PHRs encourage the addition of annotation and supervised self-monitoring2. On the other hand, as Swan shows, apps and sensors can mimic real life and offer the benefits of the quantified self.
Patient at the centre It’s no secret that there are barriers to overcome. The technical skills required for decision support, data mining (especially big data) and just getting the software right are barriers to hearing the patient’s voice, and privacy, security, ethics and safety are further challenges. Regulation in the interest of patient and clinical safety can slow down the pace of innovation and further mute the patient voice, as is seen in the Whole System Demonstrator project in the UK, and lack of interoperability silences the voice altogether, when content in one service cannot be shared with clinicians in another service.
“Once we open the recorded clinical interactions in the medico-legal record to the patient’s voice, the questionanswer-decision mode of a consultation or hospital visit could change into a discussion-negotiation-decision-action mode.” Dr Karen Day
A two-way conversation in the medicolegal record should place the patient voice in the centre of healthcare, as an extension of person-centred care and personalised healthcare. Once we open the recorded clinical interactions in the medico-legal record to the patient’s voice, the questionanswer-decision mode of a consultation or hospital visit could change into a discussion-negotiation-decision-action mode. Clinical care could become less about problem solving and more about supervision, coaching and monitoring so that people can live well with long-term health issues. The quantified self could represent the mutual development of capacity for preventive care and health promotion, where clinicians may be able to build wellness interventions that people download onto their phones and use ubiquitously. Specific self-care for identified longterm conditions can become part of the background conversation between clinician and patient as people live well with health issues that don’t go away.
The future is now. The technology is available and ubiquitous. People with long-term conditions want to live well, while keeping their health issues in the background. The potential of two-way conversations in the medico-legal record is only beginning to become visible in a way that can convert the snapshot album of episodic care into a life-long continuous video representing lives well-lived. The patient’s voice is crucial for the future of clinical practice. How we go about inviting that voice into the medico-legal record via portals or PHRs or apps is up to both patients and their clinicians.
References 1. Swan M. Health 2050: the realization of personalized medicine through crowdsourcing, the Quantified Self, and the participatory biocitizen. Journal of Personalized Medicine. 2012;2(3):93118. 2. Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: Definitions, benefits and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Assoc. 2006;13(2):121 - 6.
RDNS TAKES TO THE ROAD WITH MOBILE DEVICES RDNS has recently undertaken a refresh of its mobile computing device deployment, rolling out a new range of lightweight devices with improved battery life and several layers of connectivity. The organisation is also exploring the use of telehealth through its BEIP project as well as interfaces with GP software, and is also keenly watching developments with the implementation of the Aged Care Gateway and the PCEHR.
KATE MCDONALD Journalist: Pulse+IT firstname.lastname@example.org
RDNS has used mobile devices for its nurses for well over a decade and was one of the pioneers of mobile computing at the point of care in Australia. This is not a surprise, considering the highly mobile working conditions of its nurses, who visit a range of clients, many of them frail and elderly, in their homes. In what is perhaps the fifth refresh of its mobile computing fleet, this year RDNS has rolled out new Lenovo Helix convertible ultrabooks, which allow nurses to use the devices as a tablet for quick access to information but which also come with a keyboard for easier data entry.
The device roll-out and the telehealth trials are all part of the organisation’s strategy to use technology to better equip nurses with what they need in their daily work. RDNS project manager Owen Smith describes the strategy as “crafting a service model that is closely aligned to a day in the life of a nurse”, and when the organisation issued a request for tender to refresh the mobile device fleet, it provided a use case scenario illustrating a day in the life of a typical RDNS nurse.
Nurses have full access to a range of software and applications used by RDNS, including its Camillus electronic client record, designed by Ascribe, and a system called Gemino, which acts as a store-andforward back-up application to capture important data and hold it on the device even if connectivity is lost.
“When vendors come to talk to RDNS, invariably they are amazed at how mobile RDNS is,” Mr Smith says. “A lot of sales organisations think they have road warriors but they pale when they see that the nurses have 30 minutes of office time in an eight-hour day and the challenges are broad ranging. It’s not people going from city office to city office with 4G at their fingertips. It is quite the opposite – it is going into the most difficult environments.”
Connectivity is essential for RDNS nurses, many of whom travel considerable distances to see clients in their homes. The organisation is also involved in telehealth trials, including one that allows nurses staffing its Customer Service Centre to teleconference with clients to observe them taking their medications.
Full-time nurses and those who work for more than 20 hours a week are given the device to take home with them, while part-timers often share a device. There is also an agreement with the vendor that a broken device will be replaced within a day, and there are spare devices at each base in case of equipment failure.
“By creating that very close alignment, the end goal was minimum user downtime through device failure,” Mr Smith says. “We can say that an RDNS nurse always has a device instantly. It is very responsive.” RDNS has over-specified the devices to ensure reliability. They all have a minimum of an Intel i5 processor with some high-end application devices having an i7, and they all have an onboard 3G modem with a data plan so there is connectivity anywhere that Telstra has a network, which these days is about 90 per cent of the country. However, RDNS also wanted to ensure the devices connect in areas with patchy coverage, so it has asked for a little extra.“That is the sort of spec that we
“When vendors come to talk to RDNS, invariably they are amazed at how mobile RDNS is.” Owen Smith
wanted,” Mr Smith says. “4G is not as important to us, as while it has good speed it has poor coverage. We are more concerned with what is called a ‘3.5G’ technology, HSDPA-DC. That is a dual carrier technology and allows the device to connect to two adjacent cell towers at the
same time. That increases your chances of getting a signal in marginal areas.” The detachable dock in the device has a secondary battery, which allows users to keep the dock on charge while the tablet is being used. As nurses need to be able to
Owen Smith with RDNS development coordinator Julie Hampson
“We are keenly following the implementation of the Aged Care Gateway, which will have a central client record that we will have access to and the ability to contribute to.” Fiona Hearn
charge the device in their vehicle, the rapid charging capability of the device has been a great advantage, RDNS Victorian general manager, Fiona Hearn, says.
control, because it is only available electronically. And essential for clinicians, we have the full fleet of drug information like MIMS.”
Nurses also have the ability to use the system locally and turn on the signal only when they need to in order to save battery life. They are provided with access to Camillus, and there is also a separate software product for rostering staff called RosterOn that interfaces into the client record.
Ms Hearn says nurses staffing the Customer Service Centre are also able to receive calls from nurses on site, see the live record and make changes, all in near real time. With the Gemino application, if there is a momentary loss of connectivity, all of the data is kept locally and is sent when a connection is re-established. “In addition, the staff have the full compliment of Microsoft-based products, including Outlook, the internet and the intranet,” Ms Hearn says. “RDNS has a very well-developed intranet with clinical pages, information about what we doing on wounds for instance. “All of our policies and procedures are electronic which means that as we update our policy, I don’t have to send paper out everywhere and worry about version
The next step is to investigate providing telehealth capability through the devices, which is now underway. In the last few years, RDNS has done a lot of project work looking at the opportunities presented by telehealth, including the ongoing Broadband Enabled Innovation Project (BEIP), which is providing teleconferencing into people’s homes to help with medication compliance. BEIP initially used an Intel Home Care device to facilitate the teleconferencing. The trial involves a daily video conference through the Intel 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. Intel has since removed that device from the Australian market, so RDNS is now using Samsung devices and iPads in clients’ homes as the organisation wants to develop a system that can be used on any device, Ms Hearn says.
Integration with community RDNS is also investigating how to share information with GP information systems, including Precedence Health Care’s cdmNET, which has been designed to facilitate GP management plans and team care arrangements for patients with chronic illnesses. “We are also looking at the PCEHR, although we are not playing in that field yet,” Ms Hearn says. “Not that many people are, but we are certainly interested in it. We also work very closely with palliative care organisations in Victoria and some of those have enabled access for us so that our staff can actually view that in our Customer Service Centre. They are able to see into that record as well as our record. “And we are keenly following the implementation of the Aged Care Gateway, which will have a central client record that will assist service providers.” RDNS is also using simple, free technology like Google Hangouts to improve communication within the organisation and also to make better use of its expert clinicians as part of what Mr Smith calls an enterprise social network. “It’s sort of like internal crowdsourcing, where somebody who needs assistance from a colleague can very quickly locate that colleague just through a search within the directory or a keyword in a person’s profile, such as diabetes or wound specialist,” he says. “You’d immediately see a list of the colleagues that would be appropriate to provide assistance in that scenario, and then bring them to that point of care very quickly over a Hangout. “That social media context of creating groups around wounds or diabetes is an opportunity to bring together a lot of the client’s clinicians and that’s the path we are moving along at the moment.”
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) was established in 1979 as the national peak association supporting effective practice management in the healthcare sector. The Australian Association of Practice Managers: • Provides education, resources, networking, advice and assistance to promote excellence in healthcare practice management. • 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.
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 9037 1000 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 a leading global supplier of health care information technology solutions engaging across Australia for 24 years. We partner with health services ranging from tertiary referral academic hospitals to rural health facilities. Our vision of proactive health care management drives innovation to address today’s health care challenges, while creating a foundation for tomorrow. The best way to solve a challenge is through innovation as evidenced by our Forbes ranking as 13th most innovative company worldwide. Our focus for Australia is driven by realising improvement in clinical outcomes. We achieve this by facilitating clinical transformation within our health services while delivering capability to manage the overall health status of the population.
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.
P: 1300 557 550 / +61 7 5478 5510 F: +61 7 5478 5520 E: email@example.com W: www.directcontrol.com.au 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
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.
EpiSoft P: +61 2 8985 6688 / 1300 799 904 E: firstname.lastname@example.org W: www.episoft.com.au 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 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: email@example.com 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.
GPsupport 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. GPA is committed to providing an accreditation program, which is flexible and understands the needs of busy GPs and practice support staff. Whilst accreditation gives practices access to the Practice Incentive Program (PIP), GPA believes it should offer benefits that go well beyond the PIP. Our program provides practices with a pathway to enhanced patient care, continuous professional satisfaction, improved practice efficiency and superior risk management. GPA ACCREDITATION plus certificates and signage remind patients that their practice has achieved a level of care and service above and beyond essential general practice standards. GPA provides a system designed to accommodate busy general practices. Among our services, we offer practices the opportunity to use technologicallyadvanced, environmentally-friendly online programs, allowing staff to upload documentation at their own pace; individually assigned client managers, supporting practices through accreditation from start to success and beyond; highly-trained and sensitive surveyors, with extensive experience in all facets of general practice; and interactive training seminars, bringing practices the latest information in standards and innovation. At GPA, we believe that accreditation should be an accomplishment, not a test, and we uphold that belief in our approach and service. For an accreditation program that will offer you assistance, support, information and satisfaction…the choice is yours.
P: +61 3 9999 1212 F: +61 3 8678 0607 E: email@example.com W: www.gpsupport.com.au Information Systems for the health care industry. When associated with GPsupport all your technology needs are completely managed, freeing you to focus on patient care and clinical operations. Your I.T is for us to worry about. Since 2008, GPsupport has been dedicated to delivering I.T solutions to General Practice, Allied Health and Aged Care providers. • • • • • •
Healthcare Centric IT Support Private Cloud Services Equipment Supply and Installation Multi-site networks Disaster Recovery Planning Accreditation Compliance
Our private cloud service is fast becoming the preferred choice for healthcare providers to relieve the pain of maintaining in-house systems while adhering to accreditation standards and your future needs.
Health Communication Network P: +61 2 9906 6633 F: +61 2 9906 8910 E: firstname.lastname@example.org 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
HealthLink P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: email@example.com 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
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
P: +61 2 9901 6400 F: +61 2 9439 6331 E: firstname.lastname@example.org W: www.meditech.com.au
P: 1800 148 165 E: email@example.com W: www.medtechglobal.com
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.
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. 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.
MEDrefer is a secure online referral tool used by GPs, Specialists and Allied Health Professionals to manage the referral process for the benefit of patients.
P: 1800 420 066 (AU) P: 0800 401 111 (NZ) E: firstname.lastname@example.org W: www.houstonmedical.net
Our multidiscipline software provides interfaces to every major manufacturer, enabling many clinics to save space by becoming completely paperless!
Medtech Global Ltd
P: 1800 556 022 E: email@example.com W: www.medrefer.com.au
“We provide time to health professionals through efficient practice management software”
Leecare Solutions P: +61 3 9339 6888 F: +61 3 9339 6899 E: firstname.lastname@example.org 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.
MEDrefer is a free service for GPs with an extensive search directory and profile of Specialists and Allied Health Professionals, a search reveals their listing in order of relevance and availability. MEDrefer provides an automatic tracking system for the GP to know if the patient attends their appointment, assisting duty of care. Now integrated with Best Practice and Genie software, as well as other systems, through the MEDrefer Manager. Join MEDrefer today to radically improve your referral process.
MIMS Australia P: +61 2 9902 7700 F: +61 2 9902 7701 E: email@example.com W: www.mims.com.au MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust. MIMS information is backed by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages. Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base. 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.
OzeScribe P: 1300 727 423 F: 1300 300 174 E: firstname.lastname@example.org W: www.ozescribe.com.au OzeScribe is the dictation and transcription solution chosen by most Australian university teaching hospitals and major private clinics. Our system is entirely flexible and can be tailored to your specific requirements, whether it be co-source or total outsource, for one doctor or a public hospital! We provide free electronic document delivery - via OzePost - to your EMR, your associate’s EMR, saving you thousands of dollars in time, packing and postage. OzeScribe is the provider of the most advanced solutions available, interfacing with most market leading PAS/Practice management solutions. OzeScribe is: • Run by doctors - for doctors. • Free NEHTA compliant electronic delivery to referring GPs etc via OzePost - powered by Argus. • Australian based and trained typists. • Superior accuracy via Quality Assurance (QA) transcription guaranteed. • Windows and Mac compatible web‑based dictation, transcription and document management portal. • Free app for iOS and Android devices. • Integrated M*Modal speech recognition technology on demand. With demonstrated time and cost saving benefits, it really does make sound business sense to let OzeScribe take care of managing your dictation, transcription and associated technology. To speak with a consultant call us now on 1300 727 423!
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.
Precision IT P: 1300 964 404 F: +61 2 8078 0257 E: firstname.lastname@example.org 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.
PicSafe Medi P: +61 3 9670 9339 E: email@example.com W: www.picsafe.com
Professional Transcription Solutions
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 (patented-provisional) is as simple as using the normal camera function on your mobile smart device except... your patient’s PicSafe Medi photo is completely secure and legally compliant in its consent, transmission, and storage.
P: 1300 768 476 E: firstname.lastname@example.org W: www.etranscriptions.com.au
Both iOS and Android compatible, PicSafe Medi simultaneously suffices patient privacy-related government regulatory requirements (including new Federal APP’s (12th March, 2014) surrounding the capture, use, and storage of medical photographs. Using PicSafe Medi, all 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 patientconsented (including authorization 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.
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.
Talk with us today about the future of your practice!
Stat Health Systems (Aust) P: +61 7 3121 6550 F: +61 7 3398 5064 E: firstname.lastname@example.org W: www.stathealth.com.au
P: 1800 061 260 E: email@example.com W: www.tg.org.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.
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.
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.
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.
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
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.
P: +61 3 9013 4445 E: firstname.lastname@example.org W: www.sysmex.com.au
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.
Sysmex is dedicated solely to helping your healthcare organisation achieve more in less time, with fewer errors and better patient outcomes.
It is widely used by practitioners and pharmacists in community and hospital settings in all Australian states and territories.
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
The March 2014 release of eTG complete includes updates of further Endocrinology topics, including disorders of bone and calcium homeostasis, and adrenal disorders.
Therapeutic Guidelines Ltd
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.
P: 1800 244 358 F: 1800 626 739 E: email@example.com W: www.webstercare.com.au
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
Webstercare is a world-leading medication management innovator and was recognised in 2013 by BRW as Australia’s sixth most innovative company. About 30 years ago, Webstercare developed Webster‑pak®, the world’s first medication dose administration aid, and today the majority of Australia’s community pharmacies use the Webster-pak system to help consumers maximise their medication use. Webstercare has since developed another 300 products and services– all developed to solve existing problems. These include MedsPro®, a system for maximising the efficiency of dispensing Webster-paks; MedsCom® Connect which connects pharmacies with aged care facilities and GPs; and MedSig® to streamline clinical medication administration processes.
VIRTUAL CONSULTING ROOMS
VConsult P: 1300 82 66 78 F: 1300 66 10 66 E: email@example.com 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.
P: 1300 933 000 F: +61 3 9284 3399 E: firstname.lastname@example.org W: www.zedmed.com.au At Zedmed, we provide general practice, specialist and allied health clinics with turnkey software solutions for their most common practice needs. We’re committed to producing best in class products and services and are consistently striving to provide additional value-added products and services to help practices work more profitably and efficiently, so our customers can focus on delivering patient care. Zedmed - Focused Innovation.
Australian Association of Practice Managers
The Art of Performance 2 0 1 4 N at i o N a l C o N f e r e N C e I A d e l A I d e Co n v e n t I o n C e n t r e I 21 â€“ 24 oC tober 2014
Adelaide â€“ october 21 â€“ 24 october 2014 â€“ Please Consider The AAPM SA/NT Committee, along with AAPMâ€™s National Committee are gearing up for a conference in October to showcase the best Adelaide has to offer. â€˜The Art of Performanceâ€™ will include opportunities to learn from each other, meeting and sharing ideas and concepts that will complement the wealth of knowledge and experience that will be our presenters - both in excellent plenary and concurrent sessions planned over three â€˜jam packedâ€™ days! Over the last nine months of planning we have collectively embraced the opportunity to meet, talk and listen to many Practice Managers from differing healthcare specialties - all enjoy various levels of expertise in their roles. Passions for practice management and healthcare service delivery run high for many of us and our Committee, here in SA/NT continue to be pivotal to the successful planning of SAâ€™s â€˜grabâ€™ at this annual event. So many great thoughts, ideas and suggestions â€“ all pressures aside, weâ€™re
up for the challenge to offer the best program possible. It is my hope that you will be lucky enough to attend. Our vision and ultimate goal is bringing to Adelaide the very best learning experience on offer for our profession. As the â€˜new kid on the blockâ€™ when it comes to Conference Convening, I am learning that this doesnâ€™t happen without great team support, a good dose of commitment and hard work, organisation and of course, cost. Our sensational sponsors and exhibitors are fundamental to our success in assisting the conference team to provide us with the very best learning â€˜money can buy.â€™ Our gratitude to them all. The Art of Performance in Adelaide - less than 175 sleeps to go! Marion McKay 2014 AAPM Conference Convenor
â€˜AAPM are delighted to be supported by the following sponsors and exhibitors we couldnâ€™t do it without you!â€™
visit the website to view the provisional program and list of invited speakers
Adding a whole new dimension to healthcare
At HealthLink we understand our products work best when they free up medical practitioners to concentrate on what they do best - personalised patient care - while giving them the accurate, timely and complete information to further enhance that care. Todayâ€™s complex, hurried healthcare environment demands patient information systems that are absolutely dependable. At HealthLink we work through every challenge to ensure our clients have nimble, fit -for- purpose systems that deliver peace of mind performance.