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Australasia’s First and Only eHealth and Health IT Magazine



18 NOVEMBER 2013

MOBILE HEALTH Haphazard apps

App developers should consult national regulators before making medical claims for their apps.

App snapshot

Pulse+IT’s round-up of some of the latest medical and health apps on the market for clinicians and patients.

Clinical IT evaluation The Australasian College of Health Informatics (ACHI) to be the national voice for advice on the success, or otherwise, of health IT implementations.

Organisations please note: The Pulse+IT eNewsletter service has expanded, with each day of the week now focused on a different part of the health sector. Aged care, allied health, medical practices and the acute sector all receive dedicated coverage, with targeted advertising opportunities for 2014 now available. To register your interest and obtain a media kit, email:

Want to keep your finger on the pulse? Pulse+IT’s companion eNewsletter service is the sector’s most trusted source of timely eHealth and Health IT news. Pulse+IT eNewsletters bring together breaking news, events, career and business opportunities, and software training sessions, keeping readers informed and up to date. Our rapidly growing list of over 9500 subscribers enjoys:

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Looking Ahead Pulse+IT welcomes feature articles and guest editorial submissions relating to the nominated edition themes, as well as articles relating to eHealth and Health IT more broadly. In addition to our daily eNewsletter service, Pulse+IT is produced in print seven times per year with the first edition for 2014 to be distributed for release in mid-February. Edition themes for 2014 are available at the Pulse+IT website.

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

About Pulse+IT Pulse+IT is Australia’s first and only Health IT magazine. With an international distribution exceeding 34,500 copies, it is also one of the highest circulating health publications in Australasia. 32,000 copies of Pulse+IT are distributed to GPs, specialists, practice managers and the IT professionals that support them. In addition, over 5,000 copies of Pulse+IT are distributed to health information managers, health informaticians, and IT decision makers in hospitals, day surgeries and aged care facilities. ISSN: 1835-1522 Contributors Dr Christopher Bain, Dr Ted Carner, Simon James, Kate McDonald, A/Prof Christopher Pearce, Dr Chandrashan Perera, Susi Tegen and Brendon Wickham. Disclaimer The views contained herein are not necessarily the views of Pulse+IT Magazine or its staff. The content of any advertising or promotional material contained herein is not endorsed by the publisher. While care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information herein, or any consequences arising from it. Pulse+IT Magazine has no affiliation with any organisation, including, but not limited to Health Services Australia, Sony, Health Scope, UBM Medica, the New Zealand College of General Practitioners, the Rural Doctors Association of Australia, or the Kimberley Aboriginal Medical Services Council, all who produce publications that include the word “Pulse” in their titles. Copyright 2013 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.



























Simon James reflects on the challenges mobile device technology presents in healthcare.

iPads in the operating theatre and Google Glass for surgical education: mHealth has the ability to transform medical practice.

TED CARNER A keen interest in the practical application of technologies to medicine sparked this doctor’s inventiveness.

BRENDON WICKHAM Implementing IT standards for healthcare is a bewilderingly complex field that needs to become more transparent and more simple.

SELECTED BITS & BYTES Clinical utility of PCEHR an urgent priority: UGPA National eHealth strategy review to be considered this year NSW local health districts go live with PCEHR clinical portal Queensland and NT roll out Multiprac infection control system Telstra makes strategic investment in Fred IT States commit to rapid eHealth integration project Virtual clinics provide high definition masterclass in medicine eHealth PKI cert renamed NASH

Pulse+IT takes a snapshot of some of the latest apps on the market for practice management, educational and clinical use.

Wellness apps are everywhere but there are some medical and health management apps worth looking at.

Two script ordering apps go head to head that make picking up medications more convenient.

A collaboration between clinicians and technologists has produced a configurable EHR for refugees.


ACHI A new expert committee within ACHI aims to become the voice of reason in evaluating the success or failure of health IT projects.

PCEHR may accept existing advanced care directives Victorian auditor-general slams HealthSmart implementation

MTAA App developers making medical claims should be aware that TGA regulations cover software that acts as a medical device.

Best Practice to integrate with MEDrefer online referral system Victoria abandons IT centralisation





Up and coming eHealth, Health, and IT events.

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






LEARNING FROM MOBILE HEALTH MISSTEPS With the fanfare generated at the release of every new mobile device hard to ignore, it’s no surprise that the plethora of smart phones and tablet devices has captured the imagination of not only consumers, but providers and organisations throughout the healthcare sector.

SIMON JAMES BIT, BComm Editor: Pulse+IT

Both the iOS App store and Google Play store, the clearing houses for applications (apps) for Apple devices and the Android mobile operating system respectively, surpassed a catalogue of one million apps in 2013. To date, these market-leading platforms have collectively recorded well over 110 billion downloads of these apps. With such a huge number of options available, the high level categorisation each of these libraries provides to assist users to find apps of interest seems to be increasingly inadequate, making it a daunting task for healthcare providers seeking quality apps to assist them in their daily work. For example, the iOS App store has over 20,000 apps in its medical category alone, with a further 25,000 apps listed in the health and fitness category. Catching up rapidly after a slower start, the Google Play store has over 9600 apps in its medical category, with nearly 23,000 more health and fitness apps available to users of Android devices.

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.

While these numbers are impressive, if only as a proxy of the levels of interest in mobile health (mHealth) technology, they say nothing about the quality of the applications in question, nor of their actual utilisation in the administration or treatment of patients.

As can be expected in what is still a relatively embryonic field, issues have started to emerge, with calls for regulation of medical apps becoming an increasing feature of mobile health reporting. Many of the issues that are being discussed are not foreign concepts to those involved in IT; issues such as data sovereignty, backup procedures, virus and malware protection have long applied to the administration of personal computers and laptops. The difference with mHealth is that the technology is far more difficult to control at an organisational level as more often than not, it is staff members and not the organisation that are supplying the technology and making decisions as to how it is utilised. With the quality of modern mobile networks affording fast and ready access to the internet, a lack of access to an organisation’s local network is no longer an impediment to healthcare providers interacting with technology, be it deemed appropriate by the organisation or otherwise. At the recent Health Information Management Association of Australia conference in Adelaide, a simple question about the bring your own device (BYOD) approach to technology in hospital workplaces sparked a flurry of examples

from both panel members and the audience highlighting where patient privacy and confidentiality is potentially being put at risk through the unsanctioned use of mobile devices. Instances of medical students taking photos on their phones and subsequently emailing them to supervising doctors, and the use of mainstream cloud services like Google Drive for the purposes of clinical hand-over were raised, as were the difficulties of trying to remedy such situations when the staff member in question was no longer with the organisation, much less contactable. The panel members noted that with the proliferation of mobile device technology, such situations are arising with increased frequency, but it was also acknowledged that a lack of suitable systems was the key driver for such behaviour. The importance of having BYOD policies in all healthcare organisations was highlighted, as was the fact that regardless of how an organisation wishes to proceed, the use of mobile devices in healthcare

organisations is happening anyway, presenting both a challenge and an opportunity for CIOs. Beyond the risks associated with patient privacy, a Pulse+IT reader’s recent experience with a clinical app bears reflection. Apple’s recent iOS 7 update had rendered this particular piece of software unlaunchable, meaning all the patient notes the doctor had stored within the app were no longer accessible. Unlike traditional computers, it is quite difficult to roll back to a previous operating system on some mobile devices, meaning that while the patient data would still exist within the doctor’s iOS 6 backup, there was no practical way to restore it to a device to regain access to the information. Given the rate of innovation in mHealth, the emergence of issues such as this is a certainty, providing valuable lessons for healthcare providers and organisations.

Win an iPad mini In preparation for the new year, Pulse+IT is seeking feedback from our readers to

inform the future editorial direction of the magazine. In keeping with this edition’s theme, we’re offering up an iPad mini (RRP $349) as a prize for one lucky survey respondent. The Pulse+IT readership survey should only take a few minutes to complete and can be found here:

Looking ahead After a short break from our print production cycle, Pulse+IT magazine will return in February 2014. For those interested in our editorial plans for next year, edition themes can now be reviewed at the Pulse+IT website, where readers will continue to enjoy breaking eHealth news throughout the summer months. I would like to extend my thanks to all of this year’s contributing writers, advertisers, subscribers and the organisations that supply the publication to their memberships. All of these individuals and organisations play an ongoing and important role in making each edition of Pulse+IT a reality.

Choose a career in health information management With increased investment in eHealth and evidence-based funding, now is a great time for health professionals to move into an emerging area of health care. QUT’s new degree in Health Information Management responds to growing demand for professionals who can support the collection, reporting, analysis and management of health information to improve decision making in health care and for health service delivery. Ranked Australia’s top uni under 50 years of age by Times Higher Education in the UK, you can be confident this is a contemporary program delivered by experienced industry professionals.

Megan Hayes, Health Information Specialist at the Mater and QUT graduate.

If you’ve completed a health science or IT-related degree you may be eligible for up to one year of credit. Find out more at

CRICOS No.00213J © QUT 2013 HLT-13-1189 19765





Guest Editorial

MOBILE HEALTH IN THE HOSPITAL The use of mobile technologies in clinical practice in the acute care sector has seen remarkable growth in the last few years. New and emerging technologies – such as the use of iPads in the operating theatre and Google Glass for surgical education – have the ability to transform medical practice when backed by strong ethico-legal principles and an evidence base. DR CHANDRASHAN PERERA MBBS, BMedSc Editor-In-Chief Journal of Mobile Technology in Medicine

Mobile technologies are being rapidly adopted in the medical field for a number of reasons. As a clinician, it’s easy to see the enormous potential that mobile technologies have to improve medical practice, especially in the hospital setting. As a medical student, I recall using Palm PDAs to look up details of drugs and rare conditions I’d never heard of, wishing they had internet access to expand their capabilities. Eventually the smartphone came along to fill this void.

a study on these visual acuity applications, and unfortunately found there was a huge discrepancy in quality between apps, with numerous wildly inaccurate applications.

Smartphones have a constant connection to the internet, limitless expansion capability through accessories, a convenient form factor, and perhaps most importantly, they are found in the pockets of most doctors.

Practical use of mHealth

I became interested in the field of mHealth after noticing that both myself and a number of colleagues were using our mobile devices in the hospital, with seemingly great success. For example, visual acuities were being tested by the bedside using apps which claimed to be as good as a Snellen acuity chart.

About the author Dr Chandrashan Perera is co-founder and co-editor-inchief of the Journal of Mobile Technology in Medicine. He is an ophthalmology registrar, and was assisted in preparing this article by co-editor-in-chief Dr Rahul Chakrabarti.

As one should do when adopting any new medical device, however, I decided to look up what the available evidence base was for using these mobile technologies. At the time, I was shocked to find the evidence base for using these technologies was quite abysmal. Out of interest, I conducted

Mobile devices, technology and research has always interested me, so I decided to help build the much needed evidence base by launching the Journal of Mobile Technology in Medicine two years ago. I am happy to report that the evidence base for mHealth is growing at a healthy rate.

In hospitals, the use of smartphone cameras by clinicians is especially popular. Many smartphones now have cameras which rival or beat the image quality of many standard cameras, and when this is combined with their in-built connectivity, a number clinical uses arise. Plastic surgeons have readily adopted smartphone cameras and there is a growing body of literature to support their use. One particularly interesting study in the context of post-operative monitoring of free flap grafts found that the use of a smartphone camera to transmit images within the team drastically increased the threatened flap salvage rate. The researchers noted a reduction of the time interval to operating theatre for patients requiring surgical re-exploration of potentially compromised grafts.

Emergency doctors have also been quick to incorporate smartphone cameras to complement a number of referrals. Images and videos of various lesions sent via messaging networks allow emergency departments to communicate with other physicians without limitations on distance or technology compatibility issues. Another common use is video messaging by junior doctors to liaise with senior colleagues to discuss cases and transmit relevant radiological findings, with numerous studies showing this to be an effective form of communication. With the rapid uptake of these exciting technologies, it is important to take a step back and explore the ethical and legal issues. In the US, the Food and Drug Administration (FDA) has released a formal guidelines document that helps clarify which mobile devices and apps will be classed as medical devices, and thus need to go through formal regulatory approval, and which do not. Whilst the guidelines don’t address all of the ethico-legal issues, it is promising to see progress, and will hopefully prompt other regulatory bodies to weigh in with their own. Some of the specific issues that need to be addressed are consent, privacy (especially with recording/transmitting devices like Google Glass, or even smartphone photography), security and integration of the evidence base.

Intra-operative iPads and Google Glass Beyond the established evidence base, there are a number of new mHealth technologies being trialled which have caught my attention and imagination. In Germany, liver surgeons are using iPads intra-operatively to help identify important structures. An iPad is loaded with 3D reconstructions of the patient’s liver vasculature and anatomy based on pre-operative scans. The iPad is placed

“One of the features of [Google Glass] that has intrigued surgeons is the ability to record video, showing the operating field from the surgeon’s perspective.” Dr Chandrashan Perera

inside a sterile sealed plastic bag, which allows surgeons to interact with it whilst scrubbed and operating. Augmented reality technology is then used to overlay the realtime image captured by the iPad camera with the preloaded 3D reconstructions, allowing surgeons to “see” where hidden vasculature is, and help identify the exact location of lesions. Another exciting new avenue is the use of Google Glass intra-operatively by the surgeon. Google Glasses are experimental new products that combine a computer, camera, microphone and a small display into a wearable set of augmented reality glasses. When worn, the screen sits just above the right eye, allowing easy access to information on screen through voice commands. Whilst this isn’t the first attempt at making such a device, the backing of Google, and the small form factor making it comfortable to wear, shows great promise. One of the features of this device that has intrigued surgeons is the ability to record video, showing the operating field from the surgeon’s perspective. This is currently being used for two primary reasons. Firstly, for educational purposes, the transmission of a live video feed of exactly what the surgeon is seeing to medical students allows much better visibility for students compared to a fixed video camera, which often ends up recording the back of the surgeon’s head rather than the operative field.

Secondly, during difficult cases, it allows a surgeon to communicate with other surgeons who can see the operative field and provide assistance, which could be invaluable for emergency operations in remote areas. A number of other potential uses for this technology outside the operating room includes displaying a patient’s medical data, history, lab results based on the patient that is currently in front of you, calculating heart rate based on imaging technology, and calling through referrals. Google Glasses are only available to a small group of beta testers at the moment, but once they become easily available and in common use, it will be fascinating to see what other uses innovative clinicians find for such a device. As a new field of medical technology, mHealth technologies vary from researchbacked practices to new ideas that seem more at home in a science fiction movie. Moving forward, it will be important to ensure that the evidence base guides the implementation of technologies, and when combined with strong ethico-legal principles, novel technologies have the ability transform medical practice. mHealth technologies have the potential to enhance medicine in the hospital, and I’m excited to follow this dynamic field to see what the next development will be that helps in my daily practice as a clinician.





Guest Editorial


AT THE FOREFRONT OF MOBILE HEALTH Ted Carner has lived an interesting life and has lived to tell many tall tales about it. Now practising as a dermatologist in Melbourne while teaching skin surgery, he is also one of the inventors of the PicSafe Medi clinical imaging app. Dr Carner recounts how his interest in mHealth was driven by necessity.

DR TED CARNER MD, MPH, FAAD, FACD Co-founder, PicSafe Medi

I’ve always been lucky. I was born that way, according to my great grandmother, whose wizened face I recall so clearly even now after 50 years, smoking a corn-cob pipe while sitting straight-backed in the middle of her wickiup floor weaving traditional Native American rugs. We grew up on “western” cattle ranches wearing moccasins, feathered headbands, and carrying around bows and arrows atop our bare-backed ponies, just like in the movies. So it wasn’t much of a leap for a young adventuresome physician, fresh out of training, to put up his hand when someone from the US Congress offered a job out in the middle of the Pacific Ocean. In fact, looking back over my life, I’ve always found my hand up whenever an adventure was to be had. Nothing better than a bold undertaking with an uncertain outcome, in my book, to test one’s mettle.

About the author Dr Ted Carner has practiced as a dermatologist in his native US and currently serves as clinical supervisor of dermatologic surgery at the Monash Medical Centre. He also maintains a part-time private practice in Melbourne.

As I recall, it took the first six months to finally relax and re-calibrate my existence to “island tempo”. Thereafter, time simply passed without human notation. On the equator, even Mother Nature refused to delineate time: there was “warm season”, and then there was “rainy, warm season”. My medical partner, a savvy Papuan trained at Port Moresby, kindly taught

me the ropes, including the meaning of “coconut telegraph” and the fact that you could never, ever, expect to do anything without everyone (and their cousins) knowing about it within a minute or so. I spent the next couple of years hopping from island to island, manning primitive yet surprisingly efficient outer-island clinics using expired drugs and battling the full gamut of tropical diseases and injuries, ranging from Loa Loa (filiariasis), malaria and Hansen’s disease (leprosy), to shark bites, a colourful variety of venereal diseases and, of course, the scourges of chronic diabetes, which was helped along by the unfortunate addition of processed western snack foods to the traditional island diet. Delivering babies, although not technically a disease, was a bit of an island epidemic of sorts, given that the average female produced 7.2 children during her reproductive lifetime. Then there was the occasional emergency surgery to perform, with the ultimate airevac of those cases requiring more than we could manage on-island, to wherever I could commandeer a jet with sufficient range to reach a hospital at the other end willing to take our underfunded patients. All good fun.

Doctor, adventurer, hack inventor It was a land of need I found myself living in and, as with most truly useful innovations, they are delivered from the womb of necessity. During those wonderfully naive and heady Pacific years, because we genuinely needed the capability, I had the opportunity to help develop and advance one of the first rudimentary telemedicine systems in the world at that time, using both military and civilian communications technology to make critical diagnostic, transport and treatment decisions; life-changing experiences for patients and a certain young medico. Remote medicine has helped mould me as a physician, a teacher and, now, as a hack inventor. Today, in times of lean healthcare budgets and ever-increasing numbers of indigent patients sitting in waiting rooms all around this great country of ours, the need to more efficiently communicate with one’s fellow healthcare practitioners has passed beyond the realm of idealism, and now sits squarely in the essential column. So what is it that is holding us back? When I was asked several years ago if I could find time to help out with teaching a bit of skin surgery, one of the first impressions I recall registering while walking through the busy public hospital corridors was the remarkable number of staff attending diligently, not only to patients, but to their mobile smart devices. I was contemplating this heaven-sent technology when the inevitable paperwork pile, including a thick tome of hospital staff policies written in standard legalese, was plopped down in front of me demanding my unconditional signatory surrender. I noted with interest whilst thumbing through this formidable policy document the inclusion

“... the need to more efficiently communicate with one’s fellow healthcare practitioners has passed beyond the realm of idealism, and now sits squarely in the essential column.” Dr Ted Carner

of a glaringly contradictory prohibition of the very same mobile communication devices I had been observing, expressly forbidding their usage for the purposes of taking essential clinical pictures that we all routinely depended upon to more efficiently manage our patient cases. (I was later told, on the QT, that so long as no one openly recognised the glaring contradiction, it was okay to take said pictures with said personal devices.) As you might have guessed by now, where I grew up, if something needed fixing, well, you fixed it.

Mr Pilgrim’s privacy principles With the help of a tech-savvy surgical colleague who was thinking along the same lines as myself, enter PicSafe Medi, the admittedly simple yet intuitively functional mobile clinical imaging system which allows every flavour of healthcare professional working out there in the trenches to interconnect for the express benefit of their patient. It lets them do so without Mr Pilgrim showing up, on scene, flashing his Privacy Commissioner’s badge Hollywood-style, and handing you a very painful patientprivacy-breach citation.

It’s no surprise that the platform was imagined, designed and developed expressly to meet the needs of our patients and we care-givers. Also not surprisingly, the application functions across the “rural-urban line”, whether or not one has immediate access to Wi-Fi, mobile service or, God forbid, an NBN hook-up. PicSafe Medi is more than a robust tool, as is commonly touted in advertising. It’s a system using secure cloud access for storage and retrieval of data that has been explicitly separated to prevent patient identification, encrypted to maximum standards, fail-safed multitudes of ways, accountable via real-time (geo/time/ device tagged) recorded logs and, finally, penetration tested and securitised by the world renowned and award-winning iWebgate’s Ghost Network/DMZ Security technology. iWebgate’s client list includes work involving the CIA, NSA and Northrop Grumman, manufacturer of the Stealth Bomber. Even my alma mater, Johns Hopkins, seems to think they do a pretty good job. Life’s a series of ongoing adventures, as I see it. And it’s worth all the work invested if something good comes out of it.





Guest Editorial


DEVELOPERS ARE HEALTH IT USERS TOO Implementing IT standards for healthcare is a bewilderingly complex field, even for experienced programmers, as behind each standard is a host of theory that can prove confronting for those itching to get in and start work. Standards adoption needs to become more participatory and more transparent.


About the author Brendon Wickham has Masters of Health (eHealth) from the University of Tasmania and has been working in the eHealth domain for eight years. He is the eHealth manager at Bayside Medicare Local in Melbourne.

My GP can send electronic scripts that a few pharmacists can scan, and he gets most pathology results in one electronic format or another. But he cannot seamlessly exchange electronically generated information about me with others. Not specialists. Nor hospitals. Nor practically anyone else in the health system. I haven’t asked him, but I’m sure he would like to be able to, especially to the level that service providers can do in other industries.

I recently implemented the Australian Medicines Terminology (AMT). The AMT contains standardised terms for medicines (terms that are themselves the result of many compromises). The task I needed it for was small but important. AMT’s standardisation makes it an ideal proposition because it removes a lot of ambiguity. A lot of decisions about how to represent medicine information have already been made, saving me time and invention.

What prevents my GP is the lack of various types of interoperability between health IT systems. All around the world, governments and non-profit organisations are trying to redress this by working on standards. Some of these standards are for clinicians, but most, being health IT, will need to be implemented by programmers. So what is it like for a programmer to actually implement a complex health IT standard?

But I found that implementing AMT is not straightforward. AMT is not a few columns in a spreadsheet. It is a subset of SNOMED CT, which is based on description logic. I didn’t need to know why it was so or why those decisions had been made. All I needed was, in the end, a bunch of columns in a spreadsheet. My implementation wasn’t elegant. It wasn’t something I’d claim was a beautifully architected piece of coding. All I had to use were the techniques, models and principles I have experience in. An expert programmer in terminology would probably tut tut at its flaws, but it did do what I wanted it to do quite well.

A standard is a compromise that gets adopted by as many as possible. That’s a simple definition to write, but it’s very hard to achieve. Compromise is a confronting concept: it means people have to change what they do, and it takes a long time to work out where compromises can be made. And a standard is not an end in itself. There’s no point to a standard if it’s not being used. It has to be implemented.

Description logic is a specialised area, not part of the experience of most programmers. In preparation I had to spend a few days just reading about AMT, trying to understand what it was.

Then I had to figure out how to use it. AMT’s implementation guide takes pains to point out that it cannot prescribe an implementation approach. The decision is left to the implementor about how best to grab the terminology and wrestle it into shape to do what they need it to do. None of this is what programmers instinctively want to do (nor what their boss is usually prepared to pay them to do). They want to understand a problem then fire up their software development tool and start coding a solution. It’s a constant itch that’s very easy to scratch. Yet behind a standard is a significant amount of theory and countless hours of consideration over the finickiest of details. Necessarily, this theory and detail are always documented. An implementor’s pathway into the standard is through a mountain of documentation. Keith Boone, a US expert in one of the main health IT standards, HL7, recently acknowledged this is a problem. Implementers, he said, don’t want theory; they want the answers the theory provides. And he pointed out something not often recognised: programmers are users too. Just as a computer user has to learn a program’s interface to make it work, a programmer has to learn languages and specifications to write a program.

too much detail than they actually need. I spoke with a few others involved in health IT standards in Australia – both standards developers and implementers – and found a similar story. There is no easy way to get direct answers. The documentation tends to be an explanation of what the standards developers did, rather than guiding an implementer on what to do.

different. It’s much more complex than anything they will have encountered before. Inpatients, outpatients, triage, diagnosis, medicines, tests, billing, patient journeys: these and more all interact in bewilderingly complicated patterns that can change before one’s eyes. The complexity is fractal: no matter what level one gazes at, the complexity is the same.

Those I spoke with had some clear advice. While it was acknowledged that it’s very hard to communicate guidance, more effort should be concentrated on doing so. The complexity won’t go away. Therefore, time must be spent on how the standard is presented, how the standard is described (what it actually does), and the problem the standard is addressing.

My advice to newbies would be to ramp up humility and leave ambition at the door. In a healthcare environment, it’s very hard to beat the ‘bandwidth’ of paper. On the other hand, new people are essential for bringing in new ideas. There is much happening outside of health that health can benefit from. One emerging health standard, FHIR, is an example of this.

If it becomes easier for a programmer to implement a standard, they would have more time to finesse the interface, and that would result in a better interface for clinicians and patients to use.

Another reason we need new people is to advocate for more open-source solutions. Open-source results in better, more flexible code. They will also be, by definition, transparent, which provides learning opportunities for everyone and stimulates innovation.

Healthcare is different Standards adoption should be a participatory exercise. Pretty much everyone needs to be involved. First, clinicians need to agree what data they need (patients should also be part of this). Then governments and standards organisations need to get closer to implementers.

Finally, we need more vendors who are willing to open up their business models and invest in the future. Making that compromise to implement a standard is akin to paying a tax, and it should be, because the tax bill will be far larger if it’s delayed.

He’s not the first who feels that this needs pointing out. Out there in the wider web world, there are a few coders who vent their frustration at the difficulties they face. One Microserf even writes a blog dedicated to the topic. The language they use to describe their difficulties wouldn’t look out of place in any usability lab. If programmers are users too, then the principles of user-centred design apply equally to them.

By listening to as many of those who are trying to implement the nascent specification, the better the specification, and eventual standard, will be. It’s wellknown that a hospital CEO needs to be on the wards. Similarly, standards developers and documenters need to get in the room with implementers, trying ideas and testing them together. It’s essentially the Agile development approach.

Some of the above is starting to happen. Both HL7 and IHE, another international standards organisation, are using Connectathons, which are Agile-like. NEHTA is rolling out implementation support for SNOMED CT and AMT. openEHR is a platform co-developed by Australians and is making headway on the international stage. We’re not quite at the stage of the openness and sharing in other sectors, but it’s getting there.

Mr Boone argues that this doesn’t happen. An implementer is confronted with far

Programmers new to the sector need to come to terms with healthcare. It’s

Hopefully, my GP will benefit soon. He just doesn’t need to know how it happened.






Clinical utility of PCEHR an urgent priority: United General Practice General practice representatives have called on the new federal government to address what it says are significant clinical utility issues associated with the PCEHR.

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The United General Practice Australia (UGPA) group has issued a statement saying its members had unanimously agreed that the focus of the PCEHR needed to be redirected to clinical utility and standardisation. The move follows the resignation of all but one of NEHTA’s clinical leads, including high profile clinicians such as Mukesh Haikerwal and Nathan Pinskier, in August.

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Many of those clinicians believe the PCEHR is a worthwhile endeavour, but that there are a number of aspects that need improvement, especially ease of use for clinicians – particularly for GPs – a streamlined registration

process and meaningful use of the system. One former clinical lead who did not wish to be named told Pulse+IT that while he believes the PCEHR will be clinically useful eventually, it had become apparent that neither NEHTA nor the Department of Health were listening to the concerns of GPs who were actually using the system. AMA president Steve Hambleton (pictured) said that by “clinical utility”, doctors were referring both to information that would be useful but is not yet in the PCEHR, as well as the actual ease of use of the system. While the AMA wants greater GP involvement in every aspect of the system’s development, that does not mean taking away control from the patient, he said. “The AMA wants to make sure that clinicians

have confidence in the information that is there, that it is up to date and the most recent health summary is indeed the most recent health summary, making it clinically useful. We have no problem with the patient being fully engaged in their own health record.” Australian Medicare Local Alliance (AMLA) representative, NSW GP Tony Lembke, said what UGPA wanted to see was a system that is practical and usable in the clinical context by grassroots GPs. “We realise that’s a work in progress but it needs to remain a focus of development,” Dr Lembke said. “I think the shared health summary as designed being uploaded and curated by GPs is quite an appropriate first step because it’s clinically relevant ... and we should focus on making that work before we move on to more high level functioning.

“Let’s do one thing, build it, make it work and move on. The next thing they need to work on is a central point of truth for medication management, which would have a lot of clinical impact.” Dr Lembke said each software vendor had implemented the system differently. Some of them offer a smooth connection to the PCEHR while others are a bit clunky. “And when you do access the PCEHR, the information that is presented there is in a way that isn’t really clinically useful in that the way the medications and MBS data [is presented] is useless. It makes it difficult to … find what you’re

wanting in a reasonable way. ” Andrew Howard, former head of the PCEHR with NEHTA, said one of the problems with the PCEHR at the general practice end was the poorly designed interfaces in GP software. He said the provider portal that acute care clinicians are using is a much better designed product, and that some of the criticism about clinical utility was probably due to usability in the general practice environment, which he says is very poor. “Frankly, the software vendors did the minimum amount to connect and get the practice compliant

with the connectivity requirements of the PIP payment, but they didn’t actually look at the clinical process flows in most cases,” Mr Howard said. “So you’ve got poorly designed screens and poor interfaces in that environment. As part of the certification process for practice software, software doesn’t actually need to go through a clinical usability test as part of the certification. So that’s the sort of issues in the GP environment.” The federal government has promised to review the PCEHR, telling Pulse+IT when in opposition that it would do a”stocktake” of the system if it gained government. Health Minister Peter Dutton also committed to reviewing the system as part of his preelection eHealth policy. In its statement, the UGPA said “significant issues” with the system had been identified and it was “calling on government to implement strategies to ensure the PCEHR is best structured to improve the health outcomes of all Australians. The process should be profession led and include GP input at every level of the PCEHR development life cycle, the group said. It also wants the government to ensure that secure messaging interoperability is a priority.

DVA implements PCEHRenabled case management Melbourne-based IT consulting firm Sinapse has completed the deployment of the Penelope case management system from Canadian firm Athena Software for the Department of Veterans’ Affairs (DVA). The new web-based system replaces the Veterans and Veterans Families Counselling Service’s (VVCS) management information system, known as VMIS. VVCS provides mental health counselling programs to Australian veterans, peacekeepers and their families by psychologists and social workers. The DVA also provides rehabilitation and home care services. Part of the tender for the new system was a requirement that it interface with the Healthcare Identifiers Service and the PCEHR, which the previous system could not do. Sinapse is building the additional functionality that will accommodate the connection of Penelope to the PCEHR. Sinapse partner Noel Thurlow said the project had been implemented within four months. The DVA is also involved in a telemonitoring trial, which is using the NBN to link Gold Card holders in their homes with their general practices. The trial kicked off in the NSW town of Armidale in May and enables participants to measure their vital signs at home and have their GP and nurse coordinator remotely monitor their readings and consult by video conference or face-to-face as needed. The trial was funded by the former federal government and it is unclear if it will now be extended as planned to other NBNenabled sites in Coffs Harbour in NSW, Toowoomba in Queensland and the WA towns of Mandurah and Geraldton.





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eRX goes live with Express app for pharmacies eRx Script Exchange has officially launched its eRx Express app, which allows patients to pre-order medicines through their smartphone. The new service has been integrated into pharmacy dispensing software and with eRx’s national eScripts network, which the company says is used by 15,500 GPs and 4100 pharmacists. eRx Express uses QR codes, which will be printed on eRx prescriptions and can be scanned by compatible smartphones. The company is working with its GP software vendor partners to begin adding the QR codes to the original prescriptions. The patient then transmits the script to their preferred pharmacy, where it is received by eRx Express Q software loaded onto a Windows Surface RT tablet. The patient can also choose a preferred date and time to pick up their medications. Patients must present the original paper script to the pharmacist when they collect their meds. The app was officially launched in late October at Exhibition Pharmacy in Melbourne. Pharmacist Stephen Speirs the app would help customers organise the collection of their scripts at a convenient time. “It’s perfect for people who want to skip the busy lunch hour or fit picking up script medicines around other commitments,” Mr Speirs said. “It means that we can speed up the process for people and save on waiting time. The app is free for patients, while for pharmacists eRx Express provides a standard $50 monthly plan or a premium $60 monthly plan. Both plans include the Surface tablet with eRx Express Q software installed.

National eHealth strategy review to be considered this year Federal, state and territory health ministers will later this year examine a review of the 2008 national eHealth strategy, which is currently being conducted by Deloitte. Linda Powell, first assistant secretary for eHealth policy, change and adoption with the Department of Health, told an industry forum recently that the department had contracted Deloitte to conduct the review at the half-way point of the strategy’s 10-year roadmap. The 2008 eHealth strategy, which was written by Deloitte and was agreed to by all governments, set out a roadmap to embed eHealth within the healthcare system. Ms Powell said the “refresh” of that strategy had been requested by the health ministers at the end of 2011. Ms Powell told the forum that the 2008 strategy underpinned all of the work that has been done to develop eHealth foundations over the last five years, including the Healthcare Identifiers (HI) Service, the National Authentication Service for Health (NASH), the clinical terminology service, the National Health Services Directory (NHSD) and the National Product Catalogue (NPC), as well as standards

and specifications for conformance, compliance and accreditation, secure messaging and interoperability. The 2008 strategy also recommended the creation of individual electronic health records (IEHRs), which later became the basis for the personally controlled electronic health records (PCEHR) system. Approximately one million people have now registered for a PCEHR.

“We have a much more patientcentred approach to information sharing and we have the PCEHR...” “Five years on [from the 2008 strategy], we have come a very long way,” Ms Powell said. “We’ve got eHealth foundations … we’ve got connectivity, secure messaging interoperability happening very well in some places and a bit in others. We have a much more patientcentred approach to information sharing and we have the PCEHR, which is going to drive a lot of the directions that we go in. “We’ve got NEHTA in place, we’ve got NASH, we’ve got

the PCEHR – all of these things are happening. The NHSD, clinical terminology reference sets, the NPC – they are all in place. Obviously as part of the refresh, it is asking how well did that go and is that the sort of thing we want to build upon.” Ms Powell said the review had been contracted to Deloitte, which has undertaken consultations with the sector and peak bodies. “That has all been pulled together into a strategy that ministers will be considering later this year,” she said. “It will spell out a confirmation of a whole range of things we have been doing and set some new visions and ways forward potentially.” She said the review would look at some of the benefits that have eventuated, including medications management, care planning and coordination, and achieving the eHealth foundations recommended in the 2008 strategy. “It will also look at [whether] we need to refresh some of the governance arrangements,” she said. “That has been one of the big things we have been working on. We need – and we have – commitment and collaboration between

governments, the sector, industry and providers, so we will look at how well that has gone and what do we need to have in terms of infrastructure and systems

and processes going forward.” It will also look at adoption and meaningful use, she said. “[How] do we ensure

that doctors and the other healthcare providers actually take up and use in a meaningful way the personally controlled electronic health record.”

Calculate out-of-pocket costs with The OOP mobile web service Medical software solution provider Direct CONTROL has launched The OOP, a mobile web service that allows medical and allied health specialists to calculate out-of-pocket costs and generate or email a quote or invoice to billing staff or the patient themselves. Currently available for disciplines including specialists, assistants in surgery and anaesthetists, The OOP is not so much a traditional app but a

web service that provides access to the user’s Direct CONTROL account. The company is also offering a free limited version to new doctors or those who need a simple way to calculate fees while on the go. The full version of The OOP also allows users to view and manage their lists or appointments, search for existing patients or add new ones, verify patient details for online eligibility

checks (OEC) and direct bill Medicare. For assistants in surgery, it lets them input the surgeon’s fees and calculate results in the correct assistant item code and fee. For anaesthetists, it allocates the age modifier if relevant, and lets users select ASA gradings, enter whether the procedure is an emergency and enter the duration or start end times of the procedure. Direct CONTROL’s Robyn Peters said the company had decided that rather than writing apps for Apple or Android, The OOP was designed to run from the web browser. It is offering The OOP Independent, which Ms Peters said does what Direct CONTROL does but from a device. “However, we are giving the basic OOP away for free, so for new doctors, if they are wanting to do private billing and want to know what to charge a patient, The OOP informs them of the fund fees and the known out-ofpocket (OOP) allowed.”

PicSafe Medi integrates with Box for sharing PicSafe Medi, the Melbourne-based company that has developed a secure mobile medical imaging app, has signed an integration partnership with US-based secure content sharing company Box. The new integration is compliant with HIPAA regulations in the US, meaning healthcare providers can store and share sensitive patient data in a secure, cloudbased environment. PicSafe Medi co-founder Ted Carner said the company already had an extremely high level of security that complies with Australian legal requirements, but this integration will allow international healthcare professionals to benefit from both systems working together. The idea behind the system came from observations in hospitals of doctors taking photos of patients or wounds on their smartphones without proper consent and emailing it to colleagues, which is a breach of Australian privacy principles. The Picsafe Medi app runs on both Apple and Android platforms and allows a user to quickly snap a patient-consented medical photo and share access to the image with another colleague within a secure and legally compliant mobile healthcare imaging system. All captured data resides on a secure cloud. Dr Carner said the PicSafe Medi and Box integration added another layer of security on top of the app’s already fully compliant and robust security measures. “Security is paramount to our product, and we already have a fully watertight security system in place,” he said. “Many of our US and international colleagues in healthcare will now seamlessly gain the benefits of both services working together, and we see much potential to expand our work with Box.”





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NPS launches interactive format for online case studies NPS has released a case study on tailoring ongoing treatment for type 2 diabetes in a new online format that offers CPD points for GPs, pharmacists and nurses. The case study focuses on available treatment options for a 75-year-old male with type 2 diabetes, and is delivered in a new online format that provides immediate individual and peer results, including feedback from diabetes expert Stephen Twigg of the University of Sydney. Participants work through the clinical scenario online with interactive questions and receive immediate feedback based on their responses. The activity also provides best practice pointers that can be applied to patient care. “Users are able to access the case study on a computer or tablet and switch between devices seamlessly, meaning you can start the learning activity at the workplace and continue it on the train on the way home,” NPS MedicineWise clinical adviser Andrew Boyden said. The case study covers concepts including management of CVD risk factors and glycaemic control, an update on role of low-dose aspirin for type 2 diabetes, changes to HbA1c reporting, advantages and disadvantages of newer glucose lowering medicines, and tailoring treatment for older patients. For GPs, the case study is approved for one (category two) point under the RACGP’s QI&CPD program and for two core points in the Australian College of Rural and Remote Medicine’s PD program. Case studies are also recognised for the quality prescribing incentive (QPI) of the Practice Incentives Program (PIP), and are also accredited by the Australian Pharmacy Council for an individual pharmacist’s CPD plan.

Send a Script takes out medical Mobie in mobile app awards Mobile pharmacy app Send a Script has taken out the best in medical category at the 2013 Australian Mobile Awards (Mobies), along with five other awards including the overall Golden Mobie for best design studio start-up app for small studios. Devised by pharmacist Fabian McCann, the app allows consumers to take a photo of their prescription, SMS it to their pharmacist and arrange a time to pick the medications up. Mr McCann’s company sekSystems has also designed a dashboard app for participating pharmacies that receives the SMS and manages the dispensing process. It also sends an alert when the medications are ready.

sekSystems launched the app in June for the iPhone, and is currently working on an Android version. Payment and marketing platforms are also scheduled to be released later this year. “As a pharmacy owner and having spent a great deal of time talking with my own customers, it became very clear that there had to be an easier way to provide what is undoubtedly an essential service, the fulfilment of prescriptions,” Mr McCann said. The app was developed by Sydney company Sentia and designed by St James & Finch. Send a Script took out the Gold Mobie for best studio with less than five employees, as well as

awards for best productivity app, best new service or application, best retail and shopping app and best multi-channel integrated marketing campaign. The other finalists in the medical category were: • Up the Duff, a companion app to Kaz Cooke’s book that provides handy tips for mothers-to-be. • Better Health Channel v2 iPhone & iPad app, which provides health and medical information for consumers. • PicSafe Medi, a secure mobile medical imaging system that allows clinicians to take, transmit and store clinical photos. • My Child’s eHealth Record, designed by Deloitte for NEHTA, which allows parents to enter child development milestones and is linked to the PCEHR. • Sun Effects Booth, created by Queensland Health, which simulates the potential effects of sun exposure on the face and is aimed at changing the behaviour of young people. • Symptom Checker from insurer Medibank, which allows patients to query symptoms and receive advice on treatment options and whether to seek professional advice.

NSW local health districts go live with PCEHR clinical portal Five local health districts (LHDs) in NSW are now able to access patients’ PCEHRs through the NSW Health Clinical Portal, which allows hospital and community clinicians to view health information through commonly used software packages. Western Sydney, Nepean Blue Mountains, South Eastern Sydney and Illawarra Shoalhaven LHDs and the Sydney Children’s Hospital Network now have access to the information through Cerner’s PowerChart electronic medical record and FirstNet emergency department system, as well as the CHIME community care system. In addition to patients’ PCEHRs, clinicians can also view diagnostic images and reports contained in NSW Health’s enterprise imaging repository (EIR), which went live last year. Access to the information is enabled by an enterprise patient registry that links the different health identifiers used by hospitals, such as the patient’s medical record number (MRN), to the national Healthcare Identifiers (HI) Service. Clinicians need only click on a link that is now appearing in Cerner’s flowsheet. They are automatically linked

into the read-only NSW Health Clinical Portal, which has been built by Orion Health. According to an integration document prepared by NSW Health, some hospitals within the LHDs are also now able to send electronic discharge summaries to the PCEHR.

“... clinicians can also view diagnostic images and reports contained in NSW Health’s enterprise imaging repository, which went live last year.” This was previously only possible in NSW at St Vincent’s Hospital in Darlinghurst, which has allowed its clinicians to view patients’ PCEHRs from within its clinician information system since late last year. It is also uploading discharge summaries for all patients who have a PCEHR through the Emerging Systems CIS. The NSW Health integration document states that through the clinical portal, authorised clinicians will be able to view:

• patient demographics, including all known patient identifiers from hospitals across the state • discharge summaries from the Children’s Hospital Westmead and hospitals in the Western Sydney, Nepean Blue Mountains, South Eastern Sydney and Illawarra Shoalhaven LHDs • emergency department, inpatient and outpatient visit histories from participating hospitals • event summaries from public community health services in Western Sydney and Nepean Blue Mountains LHDs • radiological images and their associated reports • the eBlue Book, if a child is from participating LHDs in Western Sydney and Nepean Blue Mountains and their parents have elected to have an eBlue Book for their child • allergies, adverse reactions and alerts. The clinical portal is part of the HealtheNet project, which has been championed by NSW Health CIO Greg Wells. Mr Wells, who was appointed CIO in 2009, has since left Health and taken up a position at the Department of Family and Community Services.

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Future of aged care gateway plan still unclear The future of the former government’s five-year Aged Care Gateway plan is still unclear following the transfer of responsibility for aged care from the Department of Health to the new Department of Social Services (DSS), although plans to select an external delivery partner are continuing. The development of the gateway was a recommendation of the Productivity Commission’s 2011 report Caring for Older Australians, and was a feature of the previous government’s 2012 Living Longer Living Better aged care reform package. A My Aged Care website and national call centre were launched on July 1 as the first phase in the five-year rollout, with a tender for a delivery prime contractor (DPC) closing on August 9. Under the former government’s plan, the DPC was to be responsible for the majority of ICT considerations in the plan, which included a central client record – due to be launched in 2014 – and which will link to the PCEHR. “The process of engaging a delivery prime contractor is continuing,” a DSS spokesperson said. “The Department of Social Services will advise the sector on the outcome of the process in due course.” Project head Craig Harris said the gateway was a staged rollout, with the next phase the launch of a fee estimator tool to allow the community to estimate the fees that might apply for residential aged care. Mr Harris said the plan was to enable consumers to register for an aged care record and at the same time meet the requirements for the PCEHR. “If they have already registered for the PCEHR, they shouldn’t have to go through the same process again to register for My Aged Care,” he said.

Queensland and NT roll out Multiprac infection control system Queensland Health has installed Ocean Informatics’ Multiprac Infection Control (IC) system in 22 of its hospitals, with the Northern Territory also beginning to roll the system out. Queensland’s Centre for Healthcare Related Infection Surveillance and Prevention (CHRISP) first installed the system at the Gold Coast, Princess Alexandra and Royal Brisbane hospitals earlier this year, with 19 others coming on board in June. Multiprac IC has also been installed at St Vincent’s Holy Spirit Northside and St Andrew’s Toowoomba private hospitals in Queensland. The Northern Territory Department of Health began implementing the system and its sister product, Multiprac Staff

Health (SH), in its five public hospitals in August. Multiprac is built upon openEHR standards, first devised by Ocean Informatics’ founders Sam Heard and Thomas Beale. openEHR is now an international standard for the storage and management of data in electronic health records. Ocean Informatics’ national engagement manager for Multiprac, Joe Griffiths, said the Multiprac system was able to interface with pathology and patient administration systems to draw in demographic and clinical data to track healthcare associated infections (HAIs) and infectious diseases such as MRSA, C. difficile, tuberculosis, norovirus and Legionnaire’s disease.

It is a full infection management program that includes structured surveillance for surgical site infections, blood stream infections, significant organisms, contact tracing and outbreaks. Mr Griffiths said the previous systems used by Queensland Health were hospital-specific and not integrated, meaning infection control practitioners (ICPs) were not aware of cross-facility infections. However, with the introduction of the National Safety and Quality Health Service Standard 3, it is now a requirement to know if a patient has previously been in another hospital with an infection. “QH CHRISP chose Multiprac because infection control needed to be on a

single, centralised, facilitybased system with central reporting, it had to be web-based and it had to be integrated,” he said. “Admissions, discharges and transfers of all of the

patients come into our system so we know who has been in and out of hospital and where they are. “If you have someone with an infectious disease, you can find the people who

were in the ward with them. That used to take a great amount of effort and time, but now you’ve got speed of response and the ICPs can respond faster to an infection or potential outbreak.”

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Telstra makes strategic investment in Fred IT as part of expansion into health Telstra has added further to its health portfolio by taking a 50 per cent interest in community pharmacy market leader Fred IT. While the exact sum was undisclosed, Fred IT Group CEO Paul Naismith said Telstra had become a major investor in Fred IT. Fred’s previous major shareholder, the Pharmacy Guild of Australia, will retain its investment in the company. The Guild has also signed a separate memorandum of understanding with Telstra to identify opportunities to work together. Telstra Health has made several acquisitions and investments recently, including the purchase of DCA’s healthcare division, EHR vendor IP Health and a substantial investment, along with Seven West Media, in online directory and appointment booking service HealthEngine. Mr Naismith said the partnership with Telstra

“underpins Fred’s core commitment to providing IT innovation and leadership for pharmacy and pharmacy customers over the long term.” “It allows us to continue to invest strongly in eHealth and cloud computing which are vital in improving patient health and safety, creating new ways for pharmacy to service its customers and run its business. Our commitment to, and focus on, pharmacy remains our absolute priority.” Mr Naismith told Pulse+IT that he will remain as CEO and nothing would change within the management team. The head of Telstra’s health division, Shane Solomon, said the investment was part of Telstra’s ongoing focus on building capability in the health sector. “Our health strategy aims to transform how Australians experience health services by improving efficiency,

convenience, quality, and co-ordination of care,” Mr Solomon said. “Community pharmacies play a vital role in providing services and advice to millions of Australians and Fred IT Group is at the leading edge of companies offering eHealth solutions to the community, GPs and pharmacists.” “Fred has embraced eHealth solutions to offer safer, more efficient and more convenient service to the community and their GPs and pharmacists. We are looking forward to providing the support which will facilitate further growth in this area.” Former Guild president Kos Sclavos said the partnership acknowledged “the importance of pharmacists in the future of health, across the spectrum of medicine management and compliance and health records, including the cornerstone of effective health records, the medication history.”

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World’s first dementia MOOC attracts mass registrations The University of Tasmania’s Understanding Dementia massive open online course (MOOC) has attracted 9300 registrations from more than 60 countries, with plans to continue the course twice a year, starting again next March. The MOOC, which is a free 11-week course delivered online and requires about three hours a week of study, covers both the science of dementia and evidence-based strategies for care, is aimed at anyone with an interest in dementia care as well as healthcare professionals, community and residential facility support staff and people in the early stages of the disease. The MOOC is delivered on the Desire2Learn platform, one of a number of commercial broadcasting platforms that have been launched in recent years to provide MOOCs. Canadian-headquartered Desire2Learn is also used in secondary schools for online learning and has a growing Australian presence. Content includes the anatomy of the brain and nervous system and the pathology of dementia, the different diseases that cause dementia and their symptoms and diagnosis, and the effect of dementia on the person and their behaviours, and the palliation and management of these. Devised by the Wicking Dementia Research and Education Centre at UTAS, the course will soon receive university accreditation as part of a negotiated study elective unit. The university also runs a fully online Bachelor of Dementia Care. Participants only need a computer and internet connection. The course is best viewed on a full-sized PC or laptop as it uses a lot of videos that require Flash, so tablets are not recommended. However, the UTAS IT department is investigating supporting the system using browsers on iPads and Android tablets.

States commit to rapid eHealth integration project for acute care views of the PCEHR The majority of states and territories will have the ability to begin allowing acute care clinicians to view clinical documents and send discharge summaries to the PCEHR system by the end of the year. In a panel discussion at a recent ICT forum organised by the Department of Health and NEHTA, jurisdictional representatives provided an update on their respective eHealth strategies and how they planned to connect acute care to the PCEHR. No representatives from South Australia and Western Australia were on the panel, although SA has already begun sending discharge summaries from nine public hospitals and has developed software called Healthcare Information and PCEHR Services (HIPS) that is being used by other states as part of NEHTA’s unfortunately named rapid integration project (RIP). Paul McRae, the principal enterprise architect with Queensland Health, said the jurisdictions were all members of a RIP steering committee that he chairs. Mr McRae said the committee had agreed that the first steps to integrating with the PCEHR was to enable discharge summaries to be uploaded

and to allow clinicians to view clinical documents. He said Queensland Health had linked with the HI Service in January this year, and those using it were achieving an 85 per cent match rate when pulling in batches of Individual Healthcare Identifiers. NASH certificates and HPIOs were recently acquired for healthcare organisations to support the integration program, he said.

“We are looking to roll out statewide the ability to send discharge summaries to the PCEHR from all facilities.” “We are looking to roll out statewide the ability to send discharge summaries to the PCEHR from all facilities that use our enterprise discharge summary application, which is all bar about three,” he said. “And we are going to provide the ability to view PCEHR information from our clinical portal, which is called The Viewer. That will be available in around 200-plus facilities and that will all happen early in November.

“At the same time, discharge summaries in CDA format level 2 will be able to be sent point to point as well.” Yin Man, manager of NSW Health’s RIP program – better known as HealtheNet – said CDA discharge summaries and event summaries had been able to be sent to GPs and the NSW clinical repository from within the Greater Western Sydney lead site since August last year. Clinicians in Greater Western Sydney are now able to access the national system through a clinical portal, which Ms Man said would be rolled out to all public hospitals in the state over the next two years. “Our clinicians in hospitals within Greater Western Sydney have been viewing CDA discharges since last August and this year we have been integrating with the national,” she said. “All hospitals will be connected to this one portal. Things have been going quite well and we already have half a million CDA documents within our clinical repository, and we pretty much generate about 6000 a month.” Victoria’s representative on the panel, the Victorian Department of Health’s advisor on eHealth policy

and engagement, Peter Williams, did not go into much detail on his state’s plans for integrating with the PCEHR as a review of the state’s health IT sector is currently with the health minister (see page 31). It is understood that some local health districts are soon to begin sending discharge summaries to the national system, but Victoria does not have the centralised approach that the other states are taking. “With the secure messaging project that is being done in SA, while they are using different technology, the design approach is adaptable in Victoria very quickly,” Mr Williams said. “That is absolutely the core of what the RIP project is about – fast-tracking some of those things.” The Northern Territory is currently working through

a major project that it is calling the M2N, in which it is transitioning its successful My eHealth Record (MeHR) system over to the national PCEHR. For that reason, it will not go live with full discharge summary and viewing capability until March or April next year. Robert Whitehead, director of eHealth policy and strategy with the NT Department of Health, said the territory was probably going to follow Queensland and provide a combined view of both the MeHR and the PCEHR for its departmental staff. Like Victoria, Tasmania is also currently undertaking a review of its eHealth strategy. Tim Blake, deputy chief information officer with the Tasmanian Department of Health and Human Services, said Tasmania was “on the cusp”

of releasing its updated eHealth strategy, which is expected to include more details about connecting to the national system. The ACT has been very active in eHealth, with Calvary Hospital playing a large role in one of the Wave 2 projects and already having the ability to send CDA discharge summaries to the PCEHR and to GPs. ACT Health’s manager for the national eHealth project, Ian Bull, said the ACT was looking at how to quickly verify IHIs for newborn babies. “[W]e are building a consumer portal, so consumers can log in and look at their appointments for outpatients services,” Mr Bull said. “We are also building a provider portal for clinicians in the region to be able to submit referrals and get bookings.”

Online tracking of medications for older people NPS is promoting three methods for older people to keep track of their medications as part of its annual Be Medicinewise campaign, including a paper medicines list, a Medicines eList that can be created online and saved as a PDF, and its awardwinning Medicines List app for the iPhone. As part of the campaign, NPS urged older people to create a medicines list as well as encouraging them to clean out their medicines cabinet, correctly follow instructions for taking meds and to ask questions of healthcare providers. According to a survey of almost 800 people aged 65 years and older, commissioned by NPS from UMR Research, 58 per cent of older people take at least three medicines a day, but just over half keep a written list of their medications, with 30 per cent having no way of keeping track. Of those who do keep a medicines list, only 60 per cent update it each time a dose is changed and half don’t update the list every time they stop or start a medicine. Less than half bring the list with them when they visit their doctor. Part of the campaign will concentrate on encouraging older people to regularly discuss their medications and their side effects with their healthcare providers. NPS has developed a paper medicines list that can be printed out, which when folded can fit into a wallet or handbag. There is also a Medicines eList that can be saved and edited online or printed out as a PDF. It also allows users to add adverse reactions or allergies to medications along with emergency contact details. The Medicines List app launched in 2011, and has subsequently added extra functionality. It allows users to enter medicines, set alarms for taking them, add in allergies and an email function.





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CareStrong connects with people in the community Allied health services provider HealthStrong has launched a new service as part of its CareStrong community care division, introducing touchscreen-based technology to assist older people or people with disabilities to remain independent in their homes for longer. Called CareStrong Connect, the service is an internet-based solution to reduce social isolation and is already in use in the US and Germany. Designed to be used with touchscreen or mouse-operated tablets and PCs, CareStrong Connect has been designed with the assistance of geriatricians to ensure that older people and those with disabilities who cannot manage a keyboard and mouse can be kept connected with carers and families. HealthStrong’s product development manager for CareStrong Connect, Owen Nathan, said the technology was especially good for touchscreen-based devices. The interface involves large buttons that have been colour-coded for ease of use. It has full video conferencing capability and the potential to be connected wirelessly to a range of health and environmental monitoring devices. “It is an internet-based platform which was designed for communication and information – giving people access to information and services,” Mr Nathan said. Users can simply touch a photo of family members or carers, and a video call is automatically made. Voice-recorded email capability has been added so people can record an email rather than type one out, and text-to-voice technology can read an email to the user. There is also the ability to connect to pharmacies and allied health services from home, allowing users to order script refills or to book a home visit.

Virtual clinics provide high-definition masterclass in medicine The University of Wollongong’s Graduate School of Medicine has conducted two high definition “virtual clinics” across three campuses up to 1500km apart as part of a project to assist in the training of students in rural and remote locations. Part of a wider project that will also involve training students in how to conduct telehealth conferences, the virtual clinic involved staging a consultation between a psychiatrist, a GP and an actor playing the role of a patient. UoW senior lecturer in educational development, Michelle Moscova, said the virtual clinic was

essentially a “masterclass in medicine”. It can be delivered to students thousands of kilometres away – in this case to campuses in Armidale and Shoalhaven – through relatively inexpensive equipment. “We have a GP who hosts the clinic and on the same set we have a specialist,” Dr Moscova said. “In the clinics done so far, the specialist is a psychiatrist, and in this case we used a patient actor for privacy reasons.” The school is broadcasting the virtual clinic using production software called Wirecast, streamed onto the Ustream commercial streaming platform.

“From the user end, it’s like using a YouTube channel for medical practice,” Dr Moscova said. “The user end is really simple because you don’t need to download anything – you just go to a weblink and log in.” The UoW team was able to broadcast in high definition and the quality was good enough that it will be appropriate for diagnostic procedures and surgical images, she said. “We are going to trial transmitting ultrasound in one of the virtual clinics next year.” To date, the lowest speed tested for viewer connections was 40Mbps, Dr Moscova said. “While the technology may be able to

run on ADSL2, the question is whether the viewer will still be able to get high quality video and the same seamless continuity of transmission without buffering or drop-outs,” she said. “Image and sound quality on this type of virtual clinic is a priority.” The team is investigating the use of ConsultDirect,

which runs a secure, proprietary platform for telehealth provision, for the telehealth training aspect for the project. Project leader Andrew Bonney said the trial was part of a larger project to give medical students and junior doctors virtual access to specialist teaching using existing infrastructure.

“Normally this kind of interactive session requires expensive dedicated proprietary technology ... and enormously expensive equipment for transmission,” Professor Bonney said.

Would you believe we have Australia’s best conference venue ready and waiting?

“We were able to deliver a high definition interactive virtual teaching clinic ... at a very low cost.”

eHealth PKI certificate renamed as NASH The Department of Human Services (DHS) has renamed the eHealth record PKI certificate for individual access to the provider portal of the PCEHR as the National Authentication Service for Health (NASH) PKI certificate for healthcare provider individuals. It is also working to create a distinct look for NASH PKI certificates to differentiate them from Medicare PKI certificates used for claims and payments. NASH PKI certificates for individuals can only be used with the PCEHR portal and are primarily issued on a USB token. A DHS spokeswoman said the department was also investigating options to allow healthcare organisations to register for the HI Service and NASH through Health Professional Online Services (HPOS).

She said the department was also considering a single sign-on project to access HPOS through general practice software. “This is intended for low key administrative type transactions for eHealth,” she said.

“The individual device should be able to hold multiple real estate, but that is a long-term position.” NASH PKI certificates for individuals will also now be issued for two years rather than one, aligning with the NASH PKI certificates for healthcare organisations that were renamed in December 2012. These certificates, distributed on CDs, are used for secure

messaging as well as for access to the PCEHR via the B2B gateway. Current holders of any eHealth record PKI certificates will receive a NASH PKI certificate that is a two-year version automatically upon renewal. Combining the two different types of NASH on the one token or CD is part of a long-term plan but is not yet possible, NEHTA CEO Peter Fleming said. “The individual device should be able to hold multiple real estate, but that is a long-term position,” he said. “Don’t expect it in the next year or so.” A roadmap for NASH is being developed for the next two years, but two-factor or multi-factor authentication is not yet confirmed in those plans, the DHS spokeswoman said.

You are cordially invited to the Novotel Twin Waters Resort on the Sunshine Coast for the biggest and best Bp Summit yet, from Friday 14th March to Sunday 16th March 2014! Discover why your GP colleagues have given such a positive thumbs-up for past Bp Summit conferences. With eHealth front and centre for the nation as well as every GP practice as never before, we promise you a wonderful program of speakers, discussion and training at every level. Plus the opportunity for you to relax with your family and colleagues at one of Australia’s most attractive resorts – all under the same roof and conveniently accessible from Australian capitals. Phone, write or email to register your interest and we’ll send you the final program and booking details as soon as they’re available. Bring your golf clubs as well as your bucket and spade!

E: T: (07) 4155 8888



Bits & Bytes

GP and community nursing data added to NZ viewer The Shared Care View (eSCRV) electronic health record being used by clinicians in New Zealand’s Canterbury region has completed stage one of its rollout, with general practice and community nursing data now accessible. The eSCRV, which has been built on Orion Health’s Concerto clinical portal technology, was first conceptualised following the 2011 earthquake. It has since been built by partners including the Canterbury District Health Board (CDHB), primary health organisation Pegasus Health, the Canterbury Community Pharmacy Group, Nurse Maude and Orion to allow any clinician with a role in a patient’s care to access patient information at the point of care. The eSCRV has been operational for about a year but with only a minimal data set so far. Recently, patient history data from general practice and community nursing was added to the system. CDHB chief executive David Meates said that with general practice data now available to other clinicians, it now had a full patient information picture. “It now means that when a person attends a hospital, an after hours general practice service, a pharmacy, a doctor or is seen by a district nurse, their clinician will be equipped with a fuller set of information that will undoubtedly improve the safety and quality of care we can provide,” Mr Meates said. General practice, pharmacy and community healthcare data can now be viewed by both primary and secondary care clinicians. Plans are underway to regionalise the Shared Care View across PHOs and the five South Island DHBs and to expand it to include St John’s Ambulance and midwives.

Plans to incorporate existing advance care directives in the PCEHR The Department of Health is looking at the possibility of loading existing advance care directives to the PCEHR as PDFs, a method it is also considering to begin loading pathology reports to the system. While the newly elected federal government has yet to make clear its plans, DoH’s first assistant secretary for PCEHR system development and operation, Fionna Granger, told a forum for healthcare IT vendors recently that the department was working on two new releases of the PCEHR, one scheduled for November and a major upgrade next April. The November release will entail minor enhancements for consumers, providers and for administrative staff working on the system. Ms Granger said DoH was looking at some usability enhancements for the consumer portal, along with feedback on views and layouts for the National Prescription and Dispense Repository (NPDR). The major changes are scheduled for the April release, which will involve loading advance care documents and pathology and diagnostic imaging reports. For pathology, Pulse+IT understands that discussions have moved

in favour of the preferred direction of the pathology industry, which has argued that pathology reports need to be loaded as complete documents in advance of a standardised way to display results that pathologists believe is safe. Ms Granger said the department was looking at allowing “immutable” PDFs to be loaded to the PCEHR with a CDA wrapper, for pathology and diagnostic imaging reports and for advance care directives.

“We are planning to make an online tool potentially available to help people on their advance care planning journey.” “There are two key things we are trying to achieve [with advance care planning] and they have slightly different approaches,” she said. “We are trying to incorporate these type of documents into the PCEHR. We are also trying to make the process for advance care planning more available to patients so they can express their wishes, and there are two

slightly different solutions to those.” She said existing advance care directives and plans differed by state and territory, with some created as simple documents written and signed by the patient to more complex plans developed with healthcare practitioners, and those that have been developed and witnessed by legal practitioners. “There are also a number of very well-developed forms for advance care already in the community,” she said. “What we are wanting to do with the PCEHR is leverage what has already been done rather than start afresh.” She said the department was looking at the possibility of loading PDFtype documents with a wrapper that explains what the document is and who loaded it, whether that be a healthcare provider or the consumer themselves. “We can for example take the well-developed documents in the states and territories and use those,” she said. “We are also planning to make an online tool potentially available to help people on their advance care planning journey, but would load it the way they would any other document. We are getting a reasonably positive response to that.”

MetaVision chosen for state-wide rollout in NSW intensive care units iMDsoft’s MetaVision clinical information system for ICUs has been chosen by NSW Health to be installed in all of the state’s public intensive care units, replacing paper records. MetaVision, which is used in both of the ACT’s public hospitals and is being implemented in many Queensland public hospitals, will be installed in all of NSW’s adult, paediatric and neonatal ICUs. It is already used in the Sydney Adventist Hospital and Macquarie University Hospital. In Brisbane, it is being installed at the Royal Brisbane and Women’s, Princess Alexandra and Royal Children’s hospitals, joining six other hospitals

throughout the state. Brent Richards, chairman of the Queensland Statewide Intensive Care Clinical Network and director of intensive care at the new Gold Coast University Hospital, said his network had provided advice and support to NSW colleagues and would provide NSW with access to Queensland’s rollout process. MetaVision is able to interoperate with a vast range of medical devices. It can also integrate with major patient administration and clinical information systems or as a stand-alone system. MetaVision creates an electronic medical record for ICUs, offering minute-by-minute patient

information collection and display. It also has specific medication management and advanced decision support tools specific to intensive care requirements. MetaVision is able to capture information from the vast range of medical devices used in ICU and present and analyse data for better clinical decision making. At the moment, nurses must manually change the dosage levels for infusion pumps in the system but Dr Richards said it was hoped that at the new Gold Coast University Hospital the pumps would be able to interface with the system so it captures that information automatically.

uHealth targets pharmacies with asthma monitoring Sydney-based digital healthcare company uHealth has partnered with publicly listed device manufacturer iSonea to begin distributing the AirSonea asthma device in pharmacies, as well as direct to consumers online. AirSonea was listed by the Therapeutic Goods Administration (TGA) in August and is due to go on sale globally next year. It is the world’s first digital device for monitoring wheeze and comes with an AsthmaSense app that helps track symptoms, triggers, wheeze, peak flow measurements and medication usage. The device itself is held against the throat to record levels of wheeze, with the measurements sent to the AsthmaSense Cloud, where measurements and progress are recorded and can be shared with healthcare providers. The AirSonea device is the latest in digital devices being launched by uHealth, which was established earlier this year by medical device commercialisation specialists Will Knox and Jeff Reid. The partners have set up the company to not only distribute medical devices but to explore the emerging ‘digital health’ sphere, which they define as the convergence between digital technologies such as social networking, mobile connectivity and bandwidth with wireless sensors, genomics, imaging and health information systems. In May, the company launched the WiTouch Pro in Australia, the first wireless remote controlled transcutaneous electrical nerve stimulation (TENS) device for consumers. uHealth is working with iSonea to begin a marketing push for the AirSonea device in pharmacies, and to extend its use beyond the consumer to involve the pharmacist, GPs and respiratory physicians.





Bits & Bytes

coreplus ramps up eHealth strategy for allied health Allied health practice management software specialist coreplus has brought forward its implementation plans for eHealth compliance and is also working with community organisations to link them up with allied health practitioners through the software. coreplus, formerly known as Intracore, offers a cloud-based practice management solution for allied health practitioners and works with a number of third-parties such as online accounting software provider Xero to offer add-on solutions as required. It has also established what it calls a referrer partner network to help healthcare organisations find privately practicing allied health professionals, book new patients straight into their calendar and manage billing and claiming through coreplus. coreplus CEO John (Yianni) Serpanos said the company was aligning itself with a number of community and corporate organisations to promote access to allied healthcare. “They can then use the software to access the allied health users that subscribe to coreplus,” Mr Serpanos said. “It means that they have the ability to access our user base in real time and be able to implement a booking and to administer and manage the billing and claiming side of things within our product. coreplus has also appointed former Zedmed development manager Peter Davies to help manage its plans for compliance with the PCEHR and other eHealth initiatives. coreplus also works with cloud-based CRM specialist Salesforce, and has developed a network of business advisors and book-keepers to assist health providers beyond coreplus’s software.

Best Practice integrates with MEDrefer online referral service GP software vendor Best Practice is aiming to demonstrate the integration of online referral service MEDrefer into its clinical software at the General Practice Conference and Exhibition (GPCE) in Melbourne this month.

MEDrefer is a web-based platform that allows GPs to search a directory of consultants and allied health providers by their sub-specialties, location, availability and other factors like gender or languages spoken.

Best Practice chief commercial officer Craig Hodges said the company was also working hard to have National Prescription and Dispense Repository (NPDR) functionality available in the next version, along with an integrated assisted registration tool to allow doctors to register known customers for the PCEHR.

The GP can book an appointment for the patient then and there if the patient agrees, or they can generate a referral certificate listing five recommended specialists from which the patient can choose the most appropriate for their schedule and location.

“Aside from MEDrefer and other exciting releases coming up in the next version, NPDR has been a key development aim for us,” he said. “We have our heads down at the moment to make that happen.” Mr Hodges said the MEDrefer integration would allow users to access the referral service from within Best Practice. “It will be a seamless transition for communicating from the point when a referral is escalated for a specialist,” he said. “We have tried to make it as user-functional as we can so people won’t actually see the gap between the two providers.”

The referral certificate has a code number printed on it, so when the patient contacts the specialist’s rooms, the receptionist or practice manager can access the referral online and decide whether to accept it or not. MEDrefer managing director Brian Sullivan said the idea was to streamline the referral process but also to enable GPs to keep track of whether the referral had been accepted or not, and whether the patient had attended or not. “The specialist can look at the summary and say yes, we’ll accept that referral,” Mr Sullivan said. “When he accepts that referral, the instant that happens a message goes back to the

GP that I, one of the five, have accepted the referral and I’m seeing the patient on the eighth of November. The GP is now in the loop, which they have never been before. “Our system will then go back to the specialist on behalf of the GP and say please confirm that my patient attended. If the patient hasn’t attended, please indicate. If they have attended, where is my report? It will continue until the GP gets a response. “If the patient hasn’t attended, we then reverse that referral and then any one of the five can pick it up again.” MEDrefer includes a dashboard for the GP to see a list of the status of all of his or her referrals, including referrals that have been issued, replied to, rejected and completed. “This is probably the only system that follows and tracks the patient and the referral,” Mr Sullivan said. MEDrefer has been developed over a number of years but is now ready to be promoted, he said. It was initially built using Microsoft’s .NET framework, but two years ago was rebuilt using the open source web application framework Ruby on Rails.

Mr Sullivan said he expected consultants looking to build a patient base to take up the service initially, but also expects established specialists to come on board. The first accepted referral will be offered for free, after which a fee will apply.

The MEDrefer team has built up a directory of over 8000 medical specialists and 12,000 allied health practitioners. Specialists will be able to amend their contact details themselves, and indicate their availability and waiting list online.

Mr Sullivan said integration with clinical software was essential. “The integration with the GP software is very important because the doctor doesn’t want to be going into different screens,” he said. “It has to be on one.”

Calvary John James installs Stryker iSuite Calvary John James Private Hospital in the ACT has installed Stryker’s iSuite technology in its new operating theatre. All monitors and imaging equipment have been replaced by the iSuite digital technology, which is mounted on booms on the ceiling so there is no need for theatre staff to manoeuvre heavy

equipment. The iSuite digital imaging is controlled by voice commands and surgical teams have access to patient information and diagnostic results. Digital radiography, CT scans, MRIs and pathology results can all be directly routed to the theatre for the surgeon to review on flat panel monitors using Stryker’s Sidne control

system. The technology also integrates with hospital information systems and picture archiving and communications systems (PACS) to allow data storage and retrieval from the operating theatre. Calvary John James Hospital also plans to upgrade an additional theatre with the iSuite technology in the future.

WebRTC makes a splash at physiotherapy conference WebRTC technology was used to beam in two UK-based physiotherapy researchers to the recent Australian Physiotherapy Association (APA) conference, fittingly to discuss the use of telehealth for physiotherapy. WebRTC is a draft web standard for realtime video, audio and data communication between web browsers that is expected to be ratified soon by internet standards bodies. It is being looked at closely for telehealth provision as it is free, easy to use and has the potential for secure file transfer and sharing of medical images and documents. During a telephysiotherapy session, UK researchers Jill Gamlin and Annette Bishop conducted a three-way video call with session moderator Ross Iles in Melbourne using WebRTC. The presentation lasted one hour and despite latency of 380 milliseconds, poor bandwidth at one site and wireless internet at the other, the conference call did not experience any problems such as dropped connections or echo. It was conducted through Google Chrome and only required a normal laptop and internet connection. In a similar way as jpeg and mpeg allows the exchange of pictures and movies, WebRTC enables the exchange of live video communications. The co-director of the University of Queensland’s Telerehabilitation Research Unit, Trevor Russell, explained his work on video-based postoperative rehabilitation at the conference. Dr Russell is the creator of the eHAB software solution, a mobile, multi-media video conferencing system that enables telerehabilitation consultations in the home. It is being used for speech therapy and audiology as well as physiotherapy.





Bits & Bytes

Medicare Locals investing in software for mental health Perth South Coastal Medicare Local has installed the mental health (MHAGIC) edition of the Global Health’s MasterCare electronic medical record. Perth South Coastal joins Fremantle, Bentley Armadale, Perth North Metro and headspace South West in installing the product. Global Health managing director Mathew Cherian said community services across Australia were looking to extend and upgrade their mental health services. MasterCare EMR is aimed at supporting multi-disciplinary, team-based delivery of services while reporting on the variety of data required for national and statebased funding programs such as the headspace youth mental health services, the mental health nurse incentive, rural primary health services (RPHS), mental health services in rural and remote areas (MHSRRA), Access to Allied Psychological Services (ATAPS) and the Partners in Recovery (PIR) program. Mr Cherian said Medicare Locals are extending the use of the MasterCare EMR beyond mental health specific programs to enabling a single shared electronic record for patients within a region that encompasses indigenous health, after hours GP services, aged care, chronic disease management and mobile medical health services. Global Health has also recently launched MasterCare Connect, a cloud-based provider portal offering allied health and specialists secure access to client records. MasterCare Connect is an extension of the company’s ReferralNet Cloud services and combines key features of the MasterCare EMR for the collection, sharing and secure exchange of clinical documents.

Victorian Auditor-General slams HealthSmart implementation The Victorian AuditorGeneral has released a devastating critique of the implementation of the HealthSmart clinical information system in Victorian public hospitals, finding that the project has run enormously over budget, has only been fully implemented in one health service and has drawbacks that potentially pose a threat to patient safety. The Clinical ICT Systems in the Victorian Public Health Sector report, released by Auditor-General John Doyle, also severely criticised the capability of the Victorian Department of Health to handle the project, suggesting it may have given poor or incorrect advice to the government. The Auditor-General’s report investigated eight Victorian public health services, four of which took part in the HealthSmart implementation. HealthSmart involved the roll out of the Cerner clinical information system, an Oracle financial system and the iPM patient management system from CSC. It also included the introduction of InterSystems’ TrakCare as a community-based client management system. The Auditor-General’s report only looked at the Cerner implementation.

CSC and InterSystems completed their installations successfully some time ago. The HealthSmart project was established in 2003 with $323 million committed, part of which was allocated to the roll out of clinical ICT systems to 19 health services by 2007. That number was later reduced to 10.

“Some clinical ICT systems have issues that potentially affect patient safety and need to be closely monitored.” However, the AuditorGeneral’s report found that only Austin Health has fully implemented the clinical system. Eastern Health and Peninsula Health are partway through their rollouts, and the Royal Victorian Eye and Ear Hospital has since abandoned its implementation. The Auditor-General investigated these four health services along with four non-HealthSmart sites: Alfred Health, Barwon Health, the Peter MacCallum Cancer Centre and the Royal Children’s Hospital.

Alfred Health also uses the Cerner system but it was not funded as part of the HealthSmart program. Barwon Health has used the BOSSnet clinical information system very successfully since 2001, while Peter Mac and RCH developed their own internal systems in the 1990s. RCH recently went out to tender for a new clinical information system. Those implementations have all proved much less expensive than HealthSmart, and experience much broader clinician acceptance, the auditor found. “I found that poor planning and inadequate understanding of the complex requirements of designing and implementing clinical ICT systems meant that the Department of Health has delivered the HealthSmart clinical ICT system to only four Victorian health services and at a cost of $145.3 million,” Mr Doyle said. “Some clinical ICT systems have issues that potentially affect patient safety and need to be closely monitored and resolved by the department and relevant health services. “Outside the HealthSmart program, other clinical ICT systems that have been

incrementally developed with strong clinician engagement enjoy wide acceptance and support from end users. Although their functionality is not directly equivalent to the HealthSMART system, these other systems have involved significantly less capital and ongoing expenditure.” The major patient safety issue the report has uncovered concerns the

movement of a patient from one hospital department to another. In the system, the patient is considered to have been discharged once they leave a ward or department. Subsequently, previously prescribed medication, pathology and radiology orders become inactive at the receiving ward. There are also significant difficulties in using the system to manage complex

prescriptions, the report found, and that in addition to nurses and doctors being confused about these complex prescriptions, pharmacists are also finding it “tedious and time consuming” to verify orders. Mr Doyle was particularly critical of the fact that a similar audit was done in 2008, but its recommendations “were not effectively actioned by the department”.

Victoria abandons health IT centralisation Victorian health organisations will have a greater say in choosing and developing health IT systems after the state’s ministerial review panel recommended greater devolution of decision making to health boards. The Victorian government ordered the review in late 2012 following the collapse of the HealthSmart program. It was one of 10 large IT projects heavily criticised by the Victorian Ombudsman in a November 2011 report. Victorian Health Minister David Davis said the Ministerial Review of Victorian Health Sector ICT, undertaken by an independent review panel, sets out how Victoria should plan, fund, govern and implement ICT investment in health in future.

“The findings and recommendations are pragmatic, directional in nature, recognise the need to fully realise the current investment in health sector ICT and position the health system for the future, particularly to meet the challenges of moving to eHealth,” Mr Davis said. The review panel recommended greater devolution of decisionmaking to health boards but also recommended that a central governance role be retained to scrutinise major capital projects. The panel has proposed the development of a statewide health ICT plan under the guidance of a governance council, and that this council should consider mandating the adoption of basic standards such as HL7, AMT and

CDA for health service providers making new ICT investments. It recommended that once the health ICT plan is comprehensively formulated, it should then co-ordinate with national eHealth initiatives, including but not limited to the PCEHR. It recommended the governing council should ensure that any investment in PCEHR capability also supports the refinement of health service provider ICT systems that will improve health services regardless of the success or uptake of the PCEHR over time. The health department should also consider resolutions arising from the national eHealth strategy review currently being written by Deloitte, it said.



Bits & Bytes

Houston Medical first off the blocks to integrate with Xero Practice management software vendor Houston Medical has integrated the Xero online accounting software system, thought to be the first medical software specialist to do so. Xero offers a free application programming interface (API) to third-party vendors to make integration easy. The cloudbased software includes bank feeds that automatically import and categorise banking, credit card and PayPal transactions, the ability to create and send invoices and get paid online, and to use add-ons for customer relationship management, inventory, timesheets and job management. It also has a mobile app for iOS and Android to allow mobile access to user accounts, and lets users share financial data and documents with accountants and book-keepers in the cloud. The integration with Houston Medical’s has been driven by one of Houston Medical’s customers, the Sydney Eye Specialist Centre. The practice’s IT manager, Marcus Wilson, first recommended it.

RDNS weighs up the pros and cons of telehealth for medication management The Royal District Nursing Service (RDNS) is continuing its trial of video conferencing technology to manage medications for older people in their homes despite a decision by Intel to withdraw its Home Guide device from sale in Australia.

“One thing about Xero is that it was designed solely from the beginning for the cloud, and its whole philosophy has been around open integration with other cloud offerings,” Mr Wilson said. “The real appeal for us was around the seamless integration with other very cheap add-on products. We are all about cutting down our administrative burden, in areas in which practice management systems have not traditionally or logically tried to cover.”

RDNS clinical nurse lead for telehealth projects, Carol Towers, told the Australian Centre for Health Innovation annual conference in Melbourne recently that RDNS was currently in talks with other suppliers of similar technology to provide an alternative.

The Sydney Eye Specialist Centre uses for all of its practice management and clinical applications. It is also able to receive data from the multiple instruments that the ophthalmic day surgery and laser treatment specialist uses.

RDNS has been running the trial, which won a gong for outstanding innovation in ICT at the Asia Pacific Eldercare Innovation awards, since May 2012.

The project is currently in a formal evaluation phase with La Trobe University, and in the meantime participants are continuing to receive the service. 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 (pictured) observes the client as they take their meds, and checks the medications pack to ensure it is correct. “When the nurse makes the call, she brings up the Intel Health Care Management Suite and identifies the client and presses the call button, which initiates the call to the client,” Ms Towers said.

“At the client’s end, the device flashes a light and makes a sound so the client can hear the call coming in. The nurse will ask how they are feeling and do a general assessment of the client and they are prompted to take their medications.” Ms Towers said the objective was to look at an alternative service delivery model via remote video conferencing for medications management. “We wanted to see if we could empower the clients to take control of their medications management,” she said. “We also wanted to demonstrate whether it was appropriate, but also to look at the technical limitations in using video conferencing for medications management.”

RDNS is also evaluating the feasibility of rolling it out throughout the organisation. This trial involved clients in three sites, each of whom would normally receive a daily visit from a district nurse. That physical visit has been reduced to once a week, with the other six days involving a video call. Ms Towers said nurses’ travelling and face to face time had been reduced from an average of 4.2 hours a week to two. Participants were provided with the device and a broadband plan – either using ADSL2+ or a 3G/4G dongle – for free. They were also able to reduce the fees paid to RDNS for daily home visits, which normally would cost about $38 a month. In terms of IT, “the positives were that when it worked, it worked really well,” she said. “The clients actually learned to reboot their routers. Like most things there were times when they had to shut it down and reboot it and they found the Intel Guide was easy to use.

that can allow conference calls. Ms Towers said she sees particular value in telehealth for providing expert advice to nurses in the field, and RDNS is currently developing an integrated telehealth project for a stomal therapy clinical nurse consultant and for expert wound care nurses as well.

“That physical visit has been reduced to once a week, with the other six days involving a video call.” While La Trobe University is still finalising its formal evaluation, the big question remains whether telehealth is a sustainable business for RDNS. The Intel devices and others like them can be very expensive so there can be a large upfront investment required on the part of organisations looking at the technology.

“One interesting thing was that the device is such an unusual looking thing, that it would act as a prompt for the clients to take their medications. When it called, that was the time for their medications.”

However, Ms Towers said cost savings could be achieved through reduced travelling times and redirection of nursing care for more complex cases. She said the service would be sustainable if 250 or more clients were assisted in this way.

RDNS is looking for further expand its use of telehealth, using different technologies

One of the keynote speakers at the conference was UK-based telecare expert

Kevin Doughty, director of the UK’s Centre for Usable Home Technology (CUHTec). Dr Doughty said RDNS and other groups looking at introducing similar telehealth services should refer to the UK experience, where these sorts of programs have been trialled over the last decade. He urged the organisation to look beyond devices such as Intel’s to far cheaper options. “Buying boxes is not the solution; it is system redesign and minimal technology,” Dr Doughty said. “The question is whether you want to go down the same road as the UK did, making all of the same mistakes.” He said one answer lay in the development of relatively cheap smart TVs with set-top boxes that could do the job of the Intel device for a fraction of the cost. For example, the Centre for Usable Home Technology has investigated a set-top box technology developed by UK firm Red Embedded, which requires only a domestic broadband link to provide video calls via the television. “The infrastructure required is the broadband,” Dr Doughty said. “That is the biggest investment and ultimately what will give the biggest return on investment.”

Secure messaging pioneer stands aside from Argus Ross Davey, who first conceptualised the Argus secure messaging service, has stepped down from the role of general manager to take on a part-time role with the company focusing on product direction and special projects. Mr Davey was working as the foundation director of the Collaborative Centre for eHealth at the University of Ballarat when he came up with the idea of Argus as part of a project initially sponsored by the Top End Division of General Practice in Darwin in 2001. Mr Davey oversaw the design, development and support for the Argus project and became one of two founding directors of the private start-up company ArgusConnect in 2004. Tania Oldaker, previously in charge of marketing for Argus, has taken on the role of general manager of the Argus business unit. Peter Young, managing director of Argus owner DCA eHealth Solutions, now part of Telstra Health, said Mr Davey had made a substantial contribution to Argus and the messaging industry. “He has taken the Argus business from an embryonic idea to become a major brand in eHealth,” Mr Young said. Mr Davey was also the founder and inaugural president of the Medical Software Industry Association (MSIA) from 1995-1998 and also formed the Health OpenWare Foundation and the Australian Healthcare Messaging Laboratory at the Collaborative Centre for eHealth. He is also a past board member of the Health Informatics Society of Australia (HISA) and continues to be active on numerous boards and committees in eHealth sectors.





Events November



ZEDMED: RESULTS INBOX Online session p: 1300 933 000 w:



ZEDMED: SCHEDULING Online session p: 1300 933 000 w:



GPA: THE GPA WAY Online session p: +61 2 6944 4042 w:







GENIE: MAINTENANCE AND REPORTS Sydney, NSW p: +61 7 3870 4085 w:



HISA QLD: HIC 2013 QUEENSLAND REPRISE Brisbane, QLD p: +61 3 9326 3311 w:

12 NOVEMBER GPA: STERILISATION: A STEP BY STEP GUIDE - PART 1 Online session p: +61 2 6944 4042 w:




ZEDMED: BATCH LETTER WRITER Online session p: 1300 933 000 w:



HEALTH INFORMATION TECHNOLOGY WA Perth, WA p: +61 3 9326 3311 w:



GENIE: MAINTENANCE AND REPORTS Adelaide, SA p: + 61 7 3870 4085 w:



ZEDMED: ADJUSTING FINANCIALS Online session p: 1300 933 000 w:





13-15 NOVEMBER NATIONAL PRIMARY HEALTH CARE CONFERENCE 2013 Gold Coast, QLD p: +61 2 6228 0800 w:



ZEDMED: MANAGING THE RECALL SYSTEM Online session p: 1300 933 000 w:

ZEDMED: PRESCRIBING IN CLINICAL Online session p: 1300 933 000 w:




HIMAA NSW: CHRISTMAS PARTY Sydney, NSW p: +61 2 946 29770 w:







GPA: STERILISATION: A STEP BY STEP GUIDE - PART 2 Online session p: +61 2 6944 4042 w:





HISA VIC: GETS MOBILE Brisbane, QLD p: +61 3 9326 3311 w:


GPA: MARKETING TO YOUR MARKET Online session p: +61 2 6944 4042 w:



ZEDMED: ECLIPSE Online session p: 1300 933 000 w:





ZEDMED: CLINICAL TEMPLATES Online session p: 1300 933 000 w:

Save the date



HISA VIC: COMMITTEE MEETING Melbourne, VIC p: +61 3 9326 3311 w:










HISA SA: SERVICE DELIVERY AND THE POINT OF CARE Adelaide, SA p: +61 3 9326 3311 w:






ZEDMED: FLEXI REPORT Online session p: 1300 933 000 w:

ZEDMED: CDA EREFERRALS Online session p: 1300 933 000 w:



2013 IAPPANZ ‘PRIVACY UNBOUND’ SUMMIT NSW, Sydney p: +61 3 9895 4475 w:



ZEDMED: ACCESSING THE PCEHR Online session p: 1300 933 000 w:








GENIE: APPOINTMENT BOOK AND BASIC BILLING Melbourne, VIC p: + 61 7 3870 4085 w:



BEST PRACTICE SUMMIT Sunshine Coast, QLD p: + 61 7 4155 8800 w:


Online Calendar: To view a comprehensive list of eHealth, Health, and IT events, visit:







A PIPE DREAM OR A WORTHWHILE AIM? Late last year, the Australasian College of Health Informatics (ACHI) put together a program evaluation subcommittee (PES), which the college hopes will in time become the peak national group for providing advice on the merit of eHealth implementations. One prime example is the relative success or failure of the PCEHR. DR CHRISTOPHER A BAIN MBBS, Master Info Tech., MACS, FACHI A/PROF CHRISTOPHER PEARCE PhD, MFM, MBBS, FRACGP, FACRRM, FAICD, FACHI

The last three years have been a particularly active and interesting time in Australian healthcare, especially when viewed through the eyes of the health informatics community. National healthcare reforms have significantly increased eHealth activities in Australia in a raft of ways – some would say for the better, and some for the worse. The personally controlled eHealth record (PCEHR) is the most prominent example, but there are numerous large and small eHealth activities across the country; usually centred around jurisdictions, hospital networks and Medicare Locals. The Australasian College of Health Informatics (ACHI) – the peak professional group for health informaticians in Australia and New Zealand – has been active in trying to shape these initiatives for the better. In order to extend the reach of the college and to have the broader health and general communities benefit from its advice and expertise, the college has established the program evaluation subcommittee (PES) of the college council.

About the authors Dr Chris Bain and A/Prof Christopher Pearce have contributed this article on behalf of the Australasian College of Health Informatics program evaluation subcommittee. Additional information about these authors is available at the Pulse+IT website.

Amongst the ACHI membership are many active and experienced clinicians, appropriately qualified and experienced ICT, IS and IM practitioners, academics and educators in the field of health informatics and its affiliated areas. All have met stringent standards to become fellows and members. The PES draws on this breadth

of skill and experience for its membership, and has provided a vehicle to also draw on the input of healthcare consumers to relevant issues. We anticipate that this group should in time become the peak national group for providing advice to healthcare decision makers (individuals or groups), the public at large, government and the media regarding the relative merit of various proposed or actually implemented systems. This is a non-trivial challenge for the group and the college but one that we welcome as part of our responsibilities to the Australian and New Zealand communities. Established in late 2012, the aim of the PES is to ultimately be seen as the authoritative and truly independent source of advice for health industry stakeholders, government and the media regarding the relative success or failure of eHealth initiatives in Australasia. One of the drivers of the creation of the group has been the concern expressed in this publication1-2 and other places around the success or otherwise of the PCEHR initiative for example.

Aims of the committee The committee hopes to achieve this by: • collating, promulgating and reporting on evidence pertaining to major health

informatics and eHealth initiatives in Australasia, which may be driven by a national, state or specialist area of interest perspective. focusing on the post-implementation phase of projects and initiatives considered of interest to the broader health informatics community. offering in-principle support to relevant research and evaluation activities undertaken, or requested by, any independent bodies such as university departments and private consultants. undertaking research and evaluation activities alone, or in association with independent bodies such as university departments and private consultants. acting as a vehicle to crystallise the opinion of college fellows in relation to issues that pertain to associated program and evaluation activities. Such opinions in turn can help in the creation of position statements on behalf of the college. publishing its findings internal and external to the college via different media as it sees appropriate for the context of the dialogue. This may include for example, reporting via external academic literature, or reporting internally via the college council. undertaking all of the above-mentioned activities in a way that is transparent in relation to potential conflicts of interest, and in a way in which true independence of analysis is considered as a defining characteristic of the work.

Implementation complexity Implementing a healthcare system is inherently complex and therefore also complex to evaluate. One need only to look at the debate over the ‘success’ or ‘failure’ of the NHS program to understand the problem. The level of complexity increases exponentially the larger the system and the number of stakeholders. Often, patientfocused outcomes seem secondary to funding or political considerations.

“The aim of the PES is to ultimately be seen as the authoritative and truly independent source of advice for health industry stakeholders, government and the media.” Dr Chris Bain and A/Prof Chris Pearce

A truism in health informatics is “what is the problem you are trying to solve?” In turn, the question must be asked for any given system implementation: “What constitutes success?” Any single (or combination of) outcome(s) below may indicate a useful system, successfully implemented.

• The level of support for the use of the system amongst users • The ability of the organisation to sustain any change in work practices associated with the system implementation and utilisation • The usability of the system.


• Reduced clinical errors, for example prescribing errors • Reduced clinician workload, for example chasing paper copies of test results • Improved access to care • Financial improvements, such as increased income from billing or improved debt recovery • System implemented on time and within budget • Improved patient satisfaction • Improved healthcare worker satisfaction • Reduced delays in patient discharge from inpatient care

This last point needs to be emphasised. The concept of usability is one poorly understood by many people who refer to it. There are highly qualified individuals whose entire job is the design and testing of systems (including various electronic devices and software systems) from a usability perspective.

Furthermore, some of the drivers that may be considered in establishing the relative success or failure of an implemented system include:

These evaluations are not for the faint‑hearted nor for those not appropriately qualified. In particular, there is an enormous amount of contextual knowledge to be factored in order for such evaluations to be undertaken in an informed fashion. For example, there has been decades of work already in the areas of systems success and failure4 and of user

• The length of time since implemented • The technical stability of the system • The quality of the implementation of the system

Usability is not simply how “easy to use” a system is. It can be broken down into its constituent components, and these in turn can be measured. These components include the flexibility of the system, its speed, its ease of navigation, its ease of learning and its “attitude”.3





“The concept of usability is one poorly understood by many people who refer to it.” Dr Chris Bain and A/Prof Chris Pearce

acceptance of technology5 that evaluators at least need to be aware of if they are to undertake meaningful evaluations of technologies or their implementation. ACHI (through the PES) as the peak academic body for health informatics brings with it all the skills necessary to deliver independent, comprehensive analysis of any eHealth implementation.



We welcome contact from relevant organisations or individuals within the broader health and eHealth/informatics communities in relation to the activities of the PES.

References 1. Evans B. (2012) Will the PCEHR Production be Alright on the Night?



(Guest editorial). Pulse+IT Magazine, February 2012, p8. James S and McDonald K (2013) Clinical Utility of PCEHR an Urgent Priority: UPGA. Pulse+IT e-Newsletter, Friday 18/10/2013 Preece J, Rogers Y, Sharp H, Benyon D, Holland S and Carey T. (1999) Human Computer Interaction. Addison- Wesley. Pearson Education Ltd, Harlow, Essex. UK. DeLone W and McLean E. (2003). The DeLone and McLean Model of Information Systems Success: A TenYear Update. Journal of Management Information Systems, 19, 9–30. Venkatesh V, Morris M, Davis G and Davis F. (2003). User Acceptance of Information Technology: Toward a Unified View MIS Quarterly, 27, 425-478.

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MEDICAL APPS AND MOBILE HEALTH REGULATION The explosion of apps for the medical and wellness sectors has been noted by many, and the problem of developers making medical claims about their apps is also a growing issue. Both the US FDA and Australia’s TGA have released guidance on what software constitutes a medical device, so app developers are urged to consult with regulators about the claims being made for their apps. SUSI TEGEN MBA, BA, Post Grad Dip Ed, GCCM (AGSM), FARLF and FAICD Chief Executive, MTAA

About the author Susi Tegen has 20 years’ experience in the medical and health fields, most recently as CEO of the Royal Australian and New Zealand College of Ophthalmologists. The Medical Technology Association of Australia (MTAA) is the national association representing companies in the medical technology industry.

With an ageing population, the increase in the number of people with chronic diseases and an ever reducing health dollar, we need to find smarter ways to manage the health needs of Australians. In response to the looming demand for care, we are seeing the rapid adaptation of existing medical devices, and the development of new applications for monitoring and treating health conditions in the home, that can respond to this demand. An explosion in the use of smartphones has driven the development of mobile applications for everything and anything, including lifestyle and medical apps. These apps can provide an innovative solution for the self-management of a range of health problems.

to explain how a simple object such as a phone can include embedded sensors and assist in healthcare. Many “medical” apps are misclassified and it is impossible to determine how many real (i.e., validated and reliable), medical apps actually exist.

However, in some cases developers of these apps unwittingly make medical claims about health management that could constitute the app being regulated as a medical device. Although the use of apps is often viewed as a bit of fun, apps making medical claims could prevent individuals from seeking medical attention through reliance on the app to manage a disease state.

A separate concern is the purchase of apps by patients who are less likely to have the ability to assess whether an app is able to do what it claims. Consumers may have a preference for monitoring medical conditions using a smartphone app. Any app that provides medical advice may result in harm to the consumer if the advice is misleading or incorrect.

A wide range of health and medical apps can be downloaded for use on smartphones. Intel’s global director of health innovation, Eric Dishman, uses the term “consumerisation of medical devices”

Medical apps for smartphones can be purchased by both medical professionals and consumers. There is concern about the use of medical apps that have not been validated by clinicians, as a large number of mobile health apps are targeted at doctors to facilitate and improve patient healthcare, for example to perform calculations, assist with differential diagnosis or monitor the progress of patients.

Safety of medical apps for smartphones The apps stores for smartphones have thousands of “symptom checkers” and medical apps available to download, some





“Any app that provides medical advice may result in harm to the consumer if the advice is misleading or incorrect.” Susi Tegen

at no cost. Smartphone health apps fall broadly into the categories of “medical” or “wellness”, an important distinction when determining whether an app needs to be regulated. Mobile medical apps are different to wellness apps (e.g., kilojoule counters). The US Food and Drug Administration’s (FDA) definition of medical apps is that they are intended for “curing, treating, seeking treatment for, mitigating, or diagnosing a specific disease, disorder, patient state or any specific, identifiable health condition”. The distinction between wellness and medical apps can at times be unclear as many medical conditions can be helped using appropriate monitoring and other preventative measures. Medical apps designed to assist with prevention or monitoring can therefore fall into a grey area. They may have a significant impact on health but are not intended to “cure”. In some cases an app may be marketed to function as a medical device but may not actually fulfill this function. Medical apps can be efficiently and effectively used to help patients monitor their own health conditions at home (e.g., tracking heart rate or blood pressure). More sophisticated apps may replace visits to doctors or specialists and may be connected to devices such as glucometers used to assess blood sugar levels in diabetic patients, reducing stress and costs. Some smartphones even contain sensors to measure physiological signals,

for example cardiovascular disease detectors that can be worn and detect disease in real time. Additionally, laboratory on chip devices which are attached to smartphones can perform sample preparation and detection steps to run capillary electrophoresis and biomarker screening. It is hard to know which medical apps live up to their claims or are of any use to the patient or doctor given that only a small number have received regulatory clearance. For example, the accuracy of smartphone apps for diagnosing melanoma is highly variable. A recent study found that 30 per cent of melanomas were incorrectly classified as benign by smartphone apps. Likewise, it is difficult to ascertain whether apps are based on scientific evidence, are reliable and have been developed without conflict of interest (e.g., an app developed by a pharmaceutical company recommending a specific drug treatment). There is very little literature in regard to the safety of medical apps for smartphones. Safety research has looked at bacterial contamination of phones and physician distraction by smartphones, rather than the actual reliability of the medical apps being used by healthcare professionals. Smartphones are used by 85 per cent of medical professionals. A survey of clinicians found that 46 per cent reported that they utilised smartphone

apps with classification and treatment algorithms. Anybody can create an app and it can be very lucrative to do so. A study assessing microbiology-themed apps found that only 34 per cent been had been developed with the guidance of a medical expert. In most cases there are no clinical trials and no process of academic peer review in the development of a medical app. Many have lengthy disclaimers and claim to diagnose or monitor various health conditions, but in most cases the apps are not subject to any validation or regulatory oversight.

Big take-up, low use Big business is often slow to embrace new technology. Personal computers and phone cameras are good examples of technologies where industry was slow to adopt but quality improved so dramatically and was adopted by consumers in such a short time that innovation could not be ignored. The Ernst & Young Pulse of the Industry (2012) report notes that medical technology (medtech) has reached a similar juncture. Early adaptors are purchasing medical apps for smartphones that may cost less than a dollar. While they may not be able to do everything that medical devices can do, medical apps are becoming increasingly sophisticated and offer good functionality to consumers. However, research shows that while consumers snap up apps, their product lifespan is short. Pinch Media found that only 30 per cent of people purchasing iPhone apps use them the next day and that in the case of free apps the number is only 20 per cent. After one month only five per cent of iPhone app users were still using the app and after 90 days only one per cent. There are concerns that software developers are creating apps in order to access medical information. In many cases consumers do not read the fine print that

states how their information can be used. In some cases apps can access the content of SMS messages and address books. Apps may be developed internationally by individuals not operating within the confines of Australian privacy laws. One of the greatest concerns over the use of smartphone apps in clinical care is the risk of breaching patients’ confidentiality. Current regulations protecting health information stored electronically do not cover health information in medical apps. It is essential to ensure that third-party apps on a smartphone will not compromise the privacy and security of health information.

Medical app regulation Medical apps have the potential to pose a risk to public health, although to date there are no well documented cases of them doing so. However, some such apps have unwittingly made medical claims, which makes them a medical device and subject to the regulations. The regulator’s role is limited to regulation of medical devices including software. In

many cases where medical and health apps represent a grey area, the regulatory guidelines encompassing these apps should provide greater clarity of regulatory requirements to app designers. Medical devices are regulated by the Therapeutic Goods Administration (TGA) in Australia and must be included on the Australian Register of Therapeutic Goods (ARTG). The TGA’s current medical device regulatory framework provides for regulation of software for therapeutic purposes, including medical apps that meet the definition of a medical device. There are some medical software tools listed, including physician management and sleep assessment software. All medical device manufacturers and sponsors have to comply with post-market vigilance and monitoring requirements. Unless the developer is aware that their app is a medical device, they will not know to subject the app to medical device regulatory requirements. There are a wide variety of medical apps, meaning that there are a wide variety of risks, for example medication names and doses may be

uploaded incorrectly, glucose levels may be recorded incorrectly or drug allergies may be misinterpreted. As the TGA’s role is limited to regulation of medical devices and clinical software, it is recommended that app developers consult regulatory authorities to determine whether medical device regulations apply. Greater awareness about medical claims is required by the software industry to ensure that real medical apps are subject to the appropriate validations and regulatory requirements. MTAA welcomes the clarity given in the recent TGA advice on applications of the regulation to new technology. In previous submissions, MTAA has been recommending that a policy be developed to provide clarity on the regulation of smartphone applications that are marketed as being able to cure, treat, monitor or diagnose a medical condition. Appropriately regulated medical apps can provide a useful and cost-effective tool for consumers to monitor their health and wellness at home. Gain the leading edge

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APPS FOR PRACTICE AND CLINICAL USE The tidal wave of new apps keeps on coming, so Pulse+IT has put together a snapshot of some of the latest on the market for general practice and medical specialist use. This snapshot is not meant to be comprehensive, but to provide an example of a variety of apps to look out for that can be used for practice management, clinical use, medical education and in association with patients.

KATE MCDONALD Journalist: Pulse+IT

Practice management apps MBS Item Browser A Northern Territory-based GP has designed a desktop app to allows users to search for the correct MBS item number and sort commonly used items into folders according to personal preference. The MBS Item Browser app was designed by Cameron Edgell, who has a software development background and has designed a program that is still in use in his native UK. Having moved to Australia in 2007 and confronted the challenge of the almost 6000 item numbers on the MBS, Dr Edgell has pre-configured the app to include the 200 or so most commonly used items by GPs.

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.

“Most GPs would not use more than a couple of hundred item numbers and quite a few would use significantly less than that, but nonetheless, coming from the UK it is a bit of a challenge to get to grips with the MBS,” Dr Edgell says. “Given that as a GP you are using quite a lot of item numbers, it’s good to be able to have rapid access to be reminded of exactly which is the appropriate item number and what the details of using it are.” The app allows you to sort the item numbers into folders that reflect your own

usage, so you can organise the MBS as you normally you use it. Items can be sorted into folder sets and annotated with an alias and comments. Bookmarks can also be added to selected items and they can be searched by category, group and subgroup. The fee for each item is also displayed. The app also allows users to create and print out cheat sheets, which some professional organisations currently distribute to members. You can customise your own cheat sheet, update it and print it out at any time. Dr Edgell has designed MBS Item Browser as a desktop app that can also be mobilised by being saved onto a USB stick. It is an offline app but registered users will receive regular updates when the MBS is altered. The app costs $14 per user as a one-off fee, with a discount for registrars and for volume buyers. Medical Fees Online The doctor behind the EasyAssist software for surgical assistant billing has developed a new web-based database to allow doctors to quickly look up any item in the MBS and find out the fees that apply. As well as the Medicare fee schedule, Medical Fees Online (MFO) also provides the fees

from health fund gap cover schemes, the Department of Veterans Affairs and workers’ compensation bodies in different states. MFO’s developer, Michael Cappellone, is a doctor by training who does some work as a medical surgical assistant, and also happens to have a degree in IT. Dr Cappellone has launched MFO as a free resource for any doctor, including medical specialists and GPs, to quickly look up MBS items and the fees that are attached. “What I found working alongside surgeons in theatre is that there is no easy way for them to look up the schedule fees that are attached to a lot of the Medicare item numbers,” he says. “Often they’d have practice software back at their rooms and they’d have admin staff that could look that up, but there was nothing on site. There were times when I wanted to look up those fees as well. There was nowhere easy to just go and look that up on the internet.”

Dr Cappellone says there are numerous fee schedules out there from anywhere up to a dozen different health insurers or health insurance groups, and most of these fee schedules are updated several times a year.

way to calculate fees while on the go, and a paid professional version called The OOP Independent that gives users access to their Direct CONTROL database or to use its functionality without installing the full system.

“It’s quite a task to download all of those documents so I had the idea to put all of that information onto a website and have a searchable database for all of those fees.”

The full version of The OOP also allows users to view and manage their lists or appointments, search for existing patients or add new ones, verify patient details for online eligibility checks (OEC) and direct bill Medicare. The OOP Users of the Direct CONTROL medical billing software can also use The OOP, a mobile web service that allows medical and allied health specialists to calculate out-of-pocket costs and generate or email a quote or invoice to billing staff or the patient themselves. Direct CONTROL is offering two versions: a free app for doctors who need a simple

Direct CONTROL's The OOP (left) and DocAppointments' check-in app (right).

The OOP Independent costs $100 a month or $1000 a year if paid in advance for nonDirect CONTROL users. or $55 a month or $550 a year per provider for customers. Many of the online appointment booking services offer an app for patients to book on their mobiles, but DocAppointments has recently launched a check-in app for practices aimed at streamlining patient flow in the practice and freeing up receptionists’ time. The app is a simple one that can be downloaded onto an Android device that is attached by a mount to the wall. When the patient arrives at the surgery, they can bypass reception and check in themselves, much like at an airport self-check-in booth. DocAppointments founder Calin Pava, a GP at the Devonport GP Superclinic in Tasmania, says the check-in app is available only for Best Practice and PracSoft users at the moment, but it will soon also be available in Stat. The functionality is the same for all packages, he says. The company decided to go with Android devices because they are cheaper for practices to buy than iPads. “Basically, when the patient comes into the practice, if the receptionist is busy then





rather than clogging the entrance they just go to the wall, put in their name and the doctor that they have the appointment with, and the software checks that they have an appointment within an hour of the time they arrive. If the software finds an appointment, it arrives them.”

Ms Lowres said her research had shown it was a cost-effective tool for mass screening in pharmacies, and it was now being used as part of a trial by practice receptionists. Patients are screened before they see the GP, with the results ready in time for the consultation.

The patient’s status appears within the practice management software just as if a receptionist had done it manually.

The device snaps onto the back of an iPhone to record, display, store and transfer single-lead ECG rhythms wirelessly with the iECG app. Recorded rhythm strips are stored in the app and sent to a secure server that can automatically analyse the reading.

Dr Pava and his team have designed the wall mount for the tablet, which practices can purchase to go with a Galaxy tablet, or DocAppointments can supply both. They then just have to download the app, which comes with a fee of $250 a year. The company also has an app for patients available for Android and iOS that can book an appointment. Patients receive reminders through the calendar function, so practices don’t have to pay for SMSs.

Clinical apps iECG The University of Sydney is currently trialling the AliveCor health monitor for iPhone device in general practices in Sydney, following research that found it was highly successful in screening for atrial fibrillation in community pharmacies. The AliveCor device is a single-lead ECG device built into an iPhone case that has an accompanying iECG app that can analyse the readings and display them on the phone’s screen. The electrodes are rested on the fingers from each hand, and the app senses skin contact on the sensors. The app can be set to take 30-second or continuous rhythm strips. The device has been trialled in community pharmacies in research led by PhD candidate Nicole Lowres as part of a postgraduate scholarship.

It can also be sent securely to the cloud in PDF format for review by a cardiologist. id579769143 PicSafe Medi PicSafe Medi is a secure mobile medical imaging app and system that allows clinicians to take a photo of a patient or wound on a mobile device, get the patient’s consent for it to be taken and shared, send it to a secure repository and allow other clinicians to view it in a time-limited way. Developed by a plastic surgeon, a burns specialist and a dermatologist, the

iECG for AliveECG.

app has been designed to comply with electronic health record and patient privacy legislation. PicSafe Medi allows a registered user to quickly take a consented medical photo on a smartphone and share the image with another colleague in a secure way. The app runs on both iOS and Android systems and comes with a monthly subscription to use the PicSafe platform. “PicSafe Medi was designed to meet a real-time problem head on,” plastic surgeon David Hunter-Smith says. “With the majority of healthcare professionals surveyed out there now using their own camera-equipped smart devices in their practices, these devices clearly benefit our patients by helping us do our jobs better and more efficiently.” PicSafe Medi allows clinicians to obtain full patient consent – either signed or audiorecorded – for the photo, which is then encrypted and sent to a securely hosted server, called PicSafe Cloud Bank. Once stored, a short URL can be generated and sent to registered PicSafe users. This recipient can then log into the app or website and view the URL-tagged image

for a maximum of five minutes, after which the URL is inactivated and further access denied. PicSafe Medi is available on the Apple App Store and on Google Play for Android. The app is free for a period, after which a monthly subscription can be purchased for $4.99. Western Vascular app Melbourne-based vascular surgeon Gary Frydman has launched an app for his patients containing pre- and post-operative information for the management of varicose veins that can be customised for other medical specialists. The app allows the patient to take a photo of the problem area if they have follow-up questions and upload them to a secure patient gateway, where Mr Frydman can then view them and respond accordingly. Mr Frydman says that while the information contained in the app has been customised for his patients and his

practice, the app is free for anyone to use. It is currently available for Android and iOS. “It’s a bit of an experiment, but basically it is to give patients more information and control over their care,” Mr Frydman says. “There’s a lot of patient information about pre-operative and pre-procedure options for treatment and it has also got post-operative instructions, but the most important thing is a patient gateway where a patient can send me photographs of themselves. Mr Frydman, founder of the Western Vascular Centre and a visiting consultant surgeon, says he regularly received calls from at least one or two patients a week post-procedure with queries, and invariably the patient has to return to the centre to see him in person. The app was designed by US mobile medical app developer AppWorx, which can customise the app for the particular practitioner or clinic, including contact details and treatment plans.

PicSafe Medi (left) and Western Vascular Centre app (right).

The technology has far-reaching uses and would be good for leg ulcers, diabetic feet and any skin-based problem, so plastic surgeons and dermatologists would also find it useful, Mr Frydman says. iCombat HAIs app A mobile audit app based on the World Health Organisation’s 5 Moments of Hand Hygiene principles that was successfully trialled in two Sydney hospitals is now commercially available. Developed by Kimberly-Clark Professional and Visibility Solutions, the iCombat healthcare associated infections (HAIs) app has been designed for iPads and is aimed at capturing data about hand hygiene compliance in real-time. The iCombat HAIs app is part of a whole module that encompasses hand hygiene audits, compliance, auditor management, real-time dashboards, report automation and an evidence-based approach to gauge the efficiency of running hand hygiene improvement campaigns. Anesh Naidoo, category manager Asia Pacific for Kimberley-Clark Professional says all public hospitals have been reporting hand hygiene compliance data for several years, mandated by Hand Hygiene Australia (HHA), but many were still using either paper-based forms or inefficient and time-consuming spreadsheets. Parkinson’s iTest An innovative app designed to help people with Parkinson’s disease to keep track of their condition and share progress with their neurologists won the student section at the national iAwards recently. The Parkinson’s iTest app, designed by a





team of Edith Cowan University computer science students, is designed to work on iPads and other tablet devices to test the condition of a patient and share the results with their neurologist in the cloud. The tests themselves have been created by a separate team led by Bob Broadway, an IT engineer who has Parkinson’s disease. The tests include tapping and spiral exercises which demand coordination and control over motor movements. The results can be plotted on a graph and can be reviewed by the user and shared with their neurologist. Mr Broadway has been trialling the tests for over a year, with his results graphed over time. “He had a surgery and his medication was changed a couple of times, and that is reflected on the graph,” designer Jose Alvarado says. “You do your test, and then you can see the results. If you want to share it with your neurologist, you send an invitation, just like Facebook. You invite the user and they will get a notification. They have to accept it, and once they do you have to confirm again so it is secure. “Once the relationship is established, your neurologist will be able to see and access those results. The results are encrypted and stored on the cloud.” The team hasn’t yet thought about how to market the app, but they will be putting a cost on it – perhaps about $2 – when it is accepted on the App Store. They are also planning to do versions in languages other than English. Pepster Developed by Brisbane-based start-up company HSK Instruments in conjunction with experts in cystic fibrosis at the Mater Children’s Hospital and the University of Queensland, the Pepster app is aimed at assisting respiratory physiotherapy for cystic fibrosis patients.

The idea is to relieve the need for patients to travel long distances to specialist cystic fibrosis centres to monitor their progress. Pepster consists of a piece of hardware called Acquisition that collects respiratory data during the positive expiratory pressure (PEP) therapy and sends it in real time to an associated smart tablet or phone device with Pepster Apps. Pepster Apps is a suite of applications that allows the user to view, interpret or use the received data in a number of ways, including as a game for patients to perform their PEP exercises or one designed for parents to view their child’s performance and reward them accordingly. The data is pre-processed and sent over a wireless network to a server where it is processed further into information

from clinicians. The Pepster system is currently undergoing further clinical trials for a future submission for approval to the Therapeutic Goods Administration.

Education and reference CT scanning app The developers of the Crit-IQ critical care education website have launched a new iPad app that replicates a training session for medical students, registrars and consultants to learn the art of CT interpretation. The CT scanning in critical and emergency care app contains 70 fully scrollable CT scans along with audible radiology reports and allows students to study common pathologies, listen to a radiologist

The CT scanning in critical and emergency care app.

discussing them and zoom in on abnormalities. Users are then able to click on a tutorial about the particular pathology. Todd Fraser, an intensivist at the Nambour General Hospital and The Noosa Hospital in Queensland who first developed the CritIQ resource with co-founder Neil Orford, director of intensive care at The Geelong Hospital, says the app was designed for its ability to give trainees a 3D appreciation of CT scans, something not really achievable either in a textbook or a website. On an iPad, there is the ability to scroll through a full series of images, and to view them in multiple planes, such as in cross-section or longitudinally. “Then when you’ve decided what you think is the abnormality, you can put your headphones in, hit the play button and you can listen to a radiologist reporting the film in front of you,” Dr Fraser says. “Rather than just have a static report, the radiology report will say an abnormality is best seen for example in slide 56 at A3, and

you can pause it, and navigate to slide 56 and then zoom on to A3 on the grid. Then you can press play again and continue the report. Once you get to the end of that, you can click on a tutorial that reviews the abnormality that was the subject of the case.” The app is available for $10 from the iTunes store. ct-scanning-in-critical-emergency/ id554921191?mt=8 iMIMS MIMS is developing a version of its iMIMS app for Android smartphones and tablets and has also added the ability to purchase and renew the medicines information platform from directly within the app. Improvements include changes to the handling of special text characters for medicines and information containing superscript and subscript characters. The major new feature is the ability for

iMIMS abbreviated information (left) and John Murtagh’s flashcards app (right).

independent subscribers to purchase and renew iMIMS from directly within the app using Apple’s In-App Purchasing mechanism. MIMS has also added the add-on Pill Identifier module to the cost of the overall subscription, saying most users have opted to purchase the module anyway. The new price of iMIMS with the Pill ID included will be $179.99. Murtagh’s flashcards app Publisher McGraw-Hill has released an updated version of its diagnostic flashcards for general medical practice app, developed by GP, author and Monash University professor emeritus John Murtagh and based on content from his 1535-page book John Murtagh’s General Practice. The app offers more than 500 diagnostic flashcards that allow users to enhance their knowledge and quiz themselves on a variety of topics covering all disciplines. Available for the iPhone and iPad, the app enables users to search by category or review bookmarked flashcards. Notes for each card are simple to activate and review with each session giving the option to accumulate memory points. The app can also be used as a study tool for medical students, GP registrars and interns within any healthcare setting or organisation. “I have a set of hand written cards now 45 years old and was hoping the publishers would re-produce the set of cards,” Professor Murtagh says. “They went with the apps and it’s a brilliant idea. The new app gives students and health professionals the most up-to-date information, based on our research.” app/diagnostic-flashcards-for/ id573383990?mt=8






APPS FOR YOUR PATIENTS There are a host of apps that doctors can use in collaboration with their patients, some good and some not so good. Here’s a quick look at some of the consumer-focused apps that doctors might recommend to patients for basic and in-depth use in helping to manage their own healthcare.

KATE MCDONALD Journalist: Pulse+IT

Emergency ID Medical jewellery distributor Emergency ID Australia has released an app for Android and iOS that shows a user’s critical medical details as wallpaper on the locked screen of their mobile phones. The app allows users to display urgent information such as allergies and emergency contact details on the screen for easy access by paramedics, emergency services personnel and healthcare professionals. Many people with health issues store their “in case of emergency” (ICE) details on their phones, but these are not much use when the phone is password protected and the user is unconscious. The Emergency ID app is also aimed at people with severe allergies to foods or medicines, existing medical conditions like epilepsy or heart disease, and for those with dementia. In addition to displaying an emergency contact or medical condition alert on the screen, the app allows patients to store and save more detailed medical information inside the app for their own records, and to share them with doctors and healthcare professionals. Patients can list current medical conditions, allergies and reactions, history

of procedures, doctor’s details, where records are kept, insurance, medications and dosages, and emergency contact details in the app. It is is available from the Apple App Store and Google Play for $3.

My Child’s eHealth Record Launched in June and only to be used in conjunction with an existing PCEHR, NEHTA’s My Child’s eHealth Record app is based on an app designed by Deloitte and NSW Health as part of the Greater Western Sydney Wave 2 project, which has created an electronic version of the Blue Book for newborns. Available for iPhones and Android smartphones, the app allows parents to enter information such as immunisations, growth parameters and developmental milestones. It is only available for NSW users at the moment, as is the new Child Development section added to the PCEHR. While it doesn’t replace the Blue Book or its equivalents, it can contain the information normally found in the paper Blue Book, which parents normally wouldn’t carry around with them. The app includes real-time growth charts,

immunisation records and reminders, health check-related questionnaires and answers – for NSW only at present – personal notes including developmental milestones, illness and injuries, useful contacts and health information resources. Before downloading and using the app, parents must have registered their child or children for a PCEHR. The app requires users to log into the website and to enter a personally chosen pin number to access the PCEHR through the app. Babies’ measurements can be added directly to the child’s PCEHR through the app.

Save the date to vaccinate Although it is only available for the NSW vaccination schedule, NSW Health’s Save

the date to vaccinate app will hopefully be picked up by other state health departments to help parents remember their child’s vaccination schedule. Available for the iPhone and Android devices, the app allows parents to book a GP appointment straight from the app. Parents can enter their child’s name and birth date, as well as their GP’s contact details, into the app. The app will then calculate the next immunisation due date and send a series of reminders to prompt the parent to call their GP to schedule an appointment for each immunisation. Parents can make the call straight from the app. Parents can use the app on their phone or add the child’s birth date, name and postcode through the website to create a printable vaccination schedule.

The immunisation website also contains a series of downloadable brochures on the facts about vaccination, dispelling many of the myths promulgated by anti-vaccination campaigners.

FODMAPs app FODMAPs are a family of carbohydrates that Monash University research has shown appearing to trigger symptoms of irritable bowel syndrome. Standing for fermentable, oligosaccharides, disaccharides, monosaccharides and polyols, FODMAPs are an area of intense study by Monash’s Department of Gastroenterology, which has devised an app for the iPad and iPhone that helps patients with IBS to accurately judge foods that are high in these

Emergency ID app (left) and My Child's eHealth record (middle and right).





nutrients, known to be poorly absorbed by the digestive tract. The university has over the years created a formidable database of knowledge on FODMAP content of foods and has also created a special diet for patients with IBS to help them reduce or avoid foods high in these sugars, called the Monash University Low FODMAP Diet. Monash dietitian Jaci Barrett says medical papers have been published over the years listing the levels of FODMAPs, but they aren’t very accessible to the general public. “Health professionals also don’t know where to look for them,” Dr Barrett says. “We were looking for another way to get the information out there and share it in a user friendly manner. That’s when we started thinking about some sort of electronic way of sharing the information.”

The app uses a traffic light system to show which foods – and how much of it – are high in FODMAPs. Health professionals can also use it if they are caring for an IBS patient on the diet. “Instead of giving people the actual quantity of FODMAPs in foods we’ve adapted it into a low (green), moderate (orange) and high (red) traffic light system so people can easily glance at the foods on the list and know whether they are suitable or not,” Dr Barrett says. “We’ve given a bit more detail because previous food lists have said ‘these foods are high and must be avoided’, but we’ve incorporated a lot more detail into the app. A certain food might be high in FODMAPs, but if they actually eat a small serve of it, they may get away with it. For example, a food may be labelled red if you eat a whole serve, but it’s actually orange if you only

Save the date to vaccinate (left) and Monash's app for the FODMAPs diet (middle and right).

have a third. Therefore if you love that food, you can try a small amount and it may not cause you symptoms.” The app, which costs $10.49, also includes a number of recipes and menus, created by a research chef who works with the university. monash-university-low-fodmap/ id586149216?mt=8&ign-mpt=uo%3D4

Antibiotics Reminder NPS launched its Antibiotics Reminder app for iPhone and iPad last year to help patients remember to take their antibiotics correctly. The app allows users to set reminders for each dose of antibiotics, track whether doses are taken correctly and record their progress in a daily recovery diary.

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It can search for antibiotics by brand name such as Amoxil or active ingredient such as amoxicillin, with predictive text generating a list of potential matches from an inbuilt database. After selecting the form – for example, tablets – strength and how often the antibiotic is used, the app generates a set of modifiable alarms to remind the user to take each dose.

quantity and how long you have to take it, and it works out where you are up to. When it is two or three days before you run out, it flags it in a red colour and prompts you to renew it.”

When it is time for the next dose, the user receives an alert from the app and a prompt to enter whether that dose was taken on time, early, late or not at all. This information is tracked and can be reviewed later. The app also allows users to record how they feel each day and track any improvements using a recovery chart, which can be shared with carers via Facebook, Twitter or email.

”It often depends on the seasons – in spring you’ve got hay fever and allergies, and you can build up a lot of medications in the household, particularly in winter,” he says. “It can be a bit of a nightmare to manage medications for the family, which is where the app comes in.”

The free app is available for iPhone, iPad and iPod Touch. antibiotics-reminder/id532054264?mt=8

PharmaEasy The PharmaEasy app is aimed at helping parents to manage both the prescription and non-prescription medications of the whole family. Designed by Albert Thammavong and his Canberra-based company Mobiletainer, the PharmaEasy app allows users to enter the names of all of the family members and link them with their current medications. Users can enter medication details such as medication name, expiry date, dosage and cost, and to take a photo of the packet for easy identification. It also features an alert to tell users when they are running low, with the ability to send an email to the pharmacist to order a repeat. “There are some smarts behind the app,” Mr Thammavong says. “You enter the

The main idea is to help families manage their multiple medications, both prescription and non-prescription.

The app also features a handy effectiveness graph so users can enter their observations on how well the drugs are working. Mr Thammavong is keen for consumers to use the app in consultation with their pharmacist and their doctor. “At the moment there is nothing that records the history of effectiveness,” he

NPS's antibiotics reminder.

says. “This gives you your own report so you can talk to the pharmacist about how the medication is going, any improvements, and the pharmacist can give you advice on how to improve or better manage your medication regime.” The app is available from the App Store for $1.99. pharmaeasy/id645243890?mt=8

Symptom Checker While common symptom checker apps can be a bit dodgy, health insurer Medibank has used a quality evidence base for its Symptom Checker app, which was recently a finalist in the Australian Mobile Awards. The app uses as its knowledge base the Schmitt-Thompson Clinical Content, which provides the information contained in the very popular US-content app SymptomMD. Medibank has ensured that the information is tailored to the Australian market, and

allows consumers to look up treatment options for minor injuries and illnesses. It has a function that recommends users seek help or professional treatment, and also allows them to access emergency numbers and store provider details. Medibank also has a free app called Energy Balancer, which helps them measure how much exercise they need to do to burn off the calories from different food types. mobile/symptom-checker.aspx

Anxiety Release Melbourne-based clinical psychologist Mark Grant has developed a mobile app for people with stress anxiety that aims to help reduce levels of anxiety whenever and wherever they occur. The Anxiety Release app is based on non-verbal bilateral stimulation, an element of Eye Movement Desensitisation and Reprocessing (EMDR), a therapy used for people with posttraumatic stress disorder.

PharmaEasy (left) and Symptom Checker (right).

Bilateral stimulation involves focusing on alternating visual and/or auditory stimuli, and when paired with focused attention, produces decreased physical and mental tension. This process seems to have not only a calming effect on anxious people but also triggers new learning pathways in the brain.

session is a “safe place” exercise to help the large proportion of anxiety sufferers who have safety issues. It is currently available for iOS users from the iTunes store and costs $4.99. An Android version is in development.

The app is not suitable for people with epilepsy, acquired brain injury or severe or complex forms of PTSD, but mainly for those people with prolonged anxiety who dislike taking medication or who find meditation or CBT tiresome and impractical. It consists of five audio sessions, beginning with a brain training session which introduces users to the process of changing their feelings through brain stimulation. This is followed by three anxietymanagement sessions consisting of a blend of guided focused attention and bilateral stimulation. The fifth and final

Sports Bra The University of Wollongong has launched an app to help women choose the correct fitting sports bra, with the aim of encouraging healthier lifestyles, avoiding neck and back pain and reducing the need for breast reduction surgery. It might not be something that clinicians often bring up with their patients, but the developers of the app have found that ill-fitting bras and uncomfortable breast movement are part of the reason why young women often give up sport, and older women or those with large breasts are reluctant to do enough exercise. The app, called Sports Bra and available for iOS and Android, has been designed using evidence-based research by Breast Research Australia (BRA), a research centre at the University of Wollongong’s Biomechanics Research Laboratory. It was developed following feedback from physiotherapists and general practitioners. The app uses step by step instructions combined with clearly labelled photographs and high-speed movies to help users find the right bra for their exercise needs. It is recommended for use by GPs, nurses and physiotherapists with patients with back pain or who need to get more exercise as part of an overall treatment plan. The Sports Bra app is available for 99c.







APPS FOR ORDERING PRESCRIPTIONS For the first time in Australia, patients can pre-order their prescriptions from a pharmacy using a simple app on their mobile phones. There is currently a choice between two – Send a Script or eRx Express – which general practices might wish to recommend to patients.

KATE MCDONALD Journalist: Pulse+IT

The first out of the blocks in the pharmacy app market was Send a Script, a mobile app developed by Wollongong pharmacist Fabian McCann. This app has been specifically designed to be easy to use by older patients, and simply requires them to take a photo of the script on their mobile phones, choose their preferred pharmacy, SMS the photo to that pharmacy and choose a time to pick it up. All of the buttons in the app are large and easy to see, and Mr McCann specifically chose to start with a photo rather than the more complicated route of QR codes or barcodes as many mobile phones don’t contain barcode readers, but the vast majority have a reasonable quality camera. Following in Send a Script’s footsteps is eRx Express, developed by the electronic prescription exchange service eRx and backed by its parent company Fred IT. eRx Express uses the QR code scanning method, which will necessitate the codes being printed on paper prescriptions, something the company is discussing with GP clinical practice software vendors. In both cases, it is still necessary for the patient to present their paper prescriptions to the pharmacist when picking up their medications. The advent of legal electronic signatures will overcome this requirement, but that day is not yet here.

Send a Script The Send a Script app is part of a broader range of smartphone and web-based apps that Mr McCann’s company, sekSystems, hopes to integrate within pharmacy, GP and nursing home software. The app itself has a simple “tap, snap, select and send” function. Consumers tap the app to open it, take a snap of the script, select their local pharmacy, and then send the message. The simplicity of the app and its design, including bright colours and large buttons, is intended to encourage older people to use the system, Mr McCann says. “I know the younger generation is into it but we are trying to get an older demographic. Taking a pic is simpler than doing a scan or a QR code, so the simplest thing is to use an anti-shake camera phone where they can take an image, send it to the pharmacy, collect their medications, and build up some confidence in technology.” Included with the app is access to sekSystems’ interactive allChemist database, which will help them to locate a participating pharmacy. At the pharmacy end, sekSystems has developed a webbased dashboard app for participating pharmacists (pictured right) that receives

the consumer’s SMS and manages the dispensing process. When the medication is ready to be collected, it sends a notification back to the consumer. The web app only requires pharmacists to have an internet connection. The dashboard contains a number of screens through which the script is processed, including receipt of the new script, dispensing in progress, a ‘not dispensed’ screen and a dispensed screen. The app has been available for the iPhone since June. An Android version is soon to be released. Participating pharmacies pay a $500 annual fee or $162.50 per quarter.

eRx Express eRx has launched its app as part of its national eScripts network. It allows consumers to scan and pre-order their medicines from their regular pharmacy or other pharmacy of choice. The app works by scanning the QR code that will begin to appear on paper

prescriptions, replicating the eRx barcode information on each script. As the app will use individual QR codes that replicate the eRx barcode information on each script, script requests sent via eRx Express will integrate directly into the pharmacy dispensing system, saving time as there is no re-keying of data.

eRx decided to use QR codes rather than try to scan the existing eRx barcode or take a photo for ease of use,” he says. “The QR code is effectively no more than a copy of the eRx barcodes that already exist on prescription originals and repeats, but it is more easily read by the mobile phone technology.

Pharmacists will use what eRx is calling the Express Q app, a Windows 8 app that is pre-loaded onto a Windows Surface RT tablet that pharmacists receive as part of their subscription to the service. The tablet receives and displays the orders from the customer’s mobile phone.

“The eRx barcode tends to be quite wide. There are in-app barcode readers that can deal with that but it is a lot easier to go with QR codes.”

eRx’s business development and customer operations manager, Markus Windhofer, says the tablet will sit adjacent to the dispensary terminal. “The pharmacist selects the prescription order from the queue on the tablet, so when they hit the dispense button it will push the information from the tablet straight into the dispensary software,” Mr Windhofer says.

eRx is talking to the GP software vendors, most of which are integrated with eRx, to begin adding the QR codes to the original prescriptions. The company is also talking to pharmacy software vendors to get them printed on repeats. The app is free for patients, while for pharmacists eRx Express provides a standard $50 monthly plan or a premium $60 monthly plan with a logo and website link on the app. Both plans include the Surface tablet with eRx Express Q software installed.

eRX Express app interface (left) and Send a Script pharmacy order review screen (right).





Off Topic


TECHNOLOGY TO IMPROVE CARE FOR REFUGEES A group of clinicians and IT experts have come together to develop a shared electronic health record as part of Victoria’s Refugee Clinical Hub, which provides specialist care in both the acute and community settings for people with a refugee background. The CAReHR is also being used to research emerging health issues, particularly those associated with infectious diseases.

KATE MCDONALD Journalist: Pulse+IT

In early 2010, Marienne Hibbert, BeverleyAnn Biggs and colleagues won a grant from the University of Melbourne’s Institute for a Broadband-Enabled Society to develop a web-based electronic health record to better coordinate healthcare for refugees and newly arrived immigrants in Victoria. Paediatrician Georgia Paxton was awarded a fellowship from the Windermere Foundation fund to her work on the project, and a Melbourne firm, Arcitecta, was contracted to begin development of the system at the Royal Melbourne Hospital. The idea behind what has since become known as the Clinical Audit Research electronic Health Record (CAReHR) was to both share data with refugee clinics at other hospitals and also to provide realtime surveillance for emerging health issues. The project then received further funding from the Victorian Department of State Development, Business and Innovation to expand the use of the CAReHR across four hospital-based refugee health clinics, and to link the system to the primary care sector through a Refugee Clinical Hub, using the cdmNet chronic disease management solution for GPs from Precedence Health Care. Currently, the Refugee Clinical Hub is fully operational in the Refugee and Immigrant

Health Clinic at the Royal Melbourne Hospital, and the Immigrant Health Clinic at the Royal Children’s Hospital. Clinics at Dandenong Hospital and Geelong Hospital are shortly also to come on board. As part of an integrated patient care system, CAReHR provides a record that is easily configured by clinicians, can generate clinical notes, GP reports and patient care summaries automatically, can be shared between hospital and general practice clinics, and even provides basic translated lists of problems in the patient’s own language. CAReHR also has an underlying federated clinical and research database that can provide real-time surveillance of infectious diseases such as malaria, tuberculosis and hepatitis B that is already being used for health monitoring and research by the Royal Melbourne Hospital, the University of Melbourne, and the Royal Children’s Hospital and Murdoch Children’s Research Institute. The system actually had its genesis some years ago, when several members of what is a tightly knit network of clinicians with an interest in refugee health began discussing how best to link up the different clinics serving refugee families as well as to conduct better research.

This network included Dr Paxton, head of immigrant health at RCH; Professor Biggs, head of the International and Immigrant Health Research Group (IIH) in the Department of Medicine at the University of Melbourne and a consultant infectious diseases physician at RMH; and Dr Hibbert, then head of the BioGrid research platform and now clinical integration manager at Precedence Health Care.

Configurable at point of care What these clinicians all agreed was needed was a system to connect patients, practitioners, hospitals and researchers. Working with Arcitecta, what they have come up with is a system that is completely configurable at the point of care and can be used for any patient group or condition. “Refugee health is about population health, but at an escalated pace,” Dr Paxton says. “What I knew some years ago for kids from Sudan, is not always relevant for the groups from Burma, or Iraq … and there are different elements in clinical care for people arriving via boats or those have been in a detention centre. “It is an area of healthcare where you need to have excellent surveillance and responsive systems. There are particular challenges in working with groups who have multiple and complex health issues, especially when all of that care is occurring with the assistance of an interpreter.” In addition to improving surveillance and clinical audits, the network wanted to improve information flow between practitioner and to patients as well. A bespoke system designed by the clinicians themselves was the obvious answer. “They had next to no money, but I could see that it was a really good opportunity to solve some complex problems,” Arcitecta’s CTO Jason Lohrey says. “It was also something we could get our teeth into that had long legs.”

“There are particular challenges in working with groups who have multiple and complex health issues, especially when all of that care is occurring with the assistance of an interpreter.” Dr Georgia Paxton

Dr Paxton took on the job of scoping out how the different clinics worked, their particular workflows and the systems already used, and conducting focus groups of clinicians to understand what they needed from an electronic system and how to maximise dual clinical and research functionality. “I surveyed the clinicians about the 10 most frequent clinical problems they had identified in the focus groups, and asked them how we assess risk and what we look for in the history and examination,” she says. “We put all of that together and came up with specs for these problems. “We put together a set of initial screening tests as we wanted to have decent epidemiological data. At that time I started working more closely with Arcitecta and it became apparent very early on that there was scope to develop a completely configurable system, and that is the real strength of CAReHR.”

Clinical control Dr Paxton says the clinicians using the system have been able to define every point in the system without constantly referring back to the developer. “I can define all of the parameters, which might be a risk factor or a symptom or an exam finding, or it might be a screening

questionnaire. If I want to put a screen for an emerging issue or a patient satisfaction questionnaire, I can enter all of those questions and have complete control over the defining parameters. Then I can combine the parameters into a problem and I have complete control over the problem definitions, so I have a system that I can set up to collect information on common things, like asthma, or rarer diseases like malaria or leprosy. “This is flexibility that you don’t get in a large-scale product. And because I set it up, I can do whatever I need it to do. I can set it up to define all of the parameters, the pathology, and referrals – I can set up CAReHR for my service.” She also says one of the biggest strengths of the system is that clinicians don’t have to double-enter any data. “The parameter appears across different problems,” she says. “You can use it as a checkbox system because you can just tick the boxes or you can use it as a free text system for your notes. There are different user styles.” The system is based on Arcitecta’s Mediaflux technology, a data management platform that is able to manage any type of structured or unstructured data through the capture and storage of metadata fragments, stored as encoded XML. In the case of the CAReHR, it has a web-based front end but the back end is what Mr





“They had next to no money, but I could see that it was a really good opportunity to solve some complex problems.” Jason Lohrey

Lohrey describes as a loosely coupled federation of systems. “Clinicians will connect to the system locally but in the back end, those systems are interconnected in the web,” he says. “The idea is that you can create any number of interconnected federations. If one hospital wants to put this system in, and somewhere down the track it wants to share information with a clinic in another place, they can choose to have their own local interconnect. The locus of control resides with the owner of that system. They decide who comes into it, rather than having a centralised control of access.” Dr Paxton says one of the strengths of the CAReHR technology is that it is able to handle the different requirements of different clinicians and services, such as paediatricians and adult physicians. How the system is configured is in the hands of the clinicians themselves. “We used the differences in clinician requirements to develop a system that can cater for all needs,” she says. “We were developing a system to meet the needs of clinicians at four different hospitals in four different health networks, which again has enabled flexibility.” Mr Lohrey says one of the objectives of his company and its technology is to obviate IT people from most processes. “We try to build systems that put the capacity to manage the system with the people that use it,” he says.

“It drives me nuts that there are people who want to collect information in one area, and someone builds a bespoke IT system for them, and then they want to collect information from somewhere else, and someone has to build another bespoke system. Then you need another project that looks at how you get information into each system, and then another project that looks at how we interconnect them. It’s just not right in my view. “We want to create something that removes us from the process as much as possible. It didn’t seem right to me that you’ve got all of these bespoke systems – what you are doing is removing the ability for people to interconnect information easily because you’ve got all of these processes, money, people, and bureaucracy.”

Translated terms Sharing information is also something that Dr Paxton is passionate about. She regularly gives copies of everything she writes to the patient, but for her nonEnglish speaking families, that usually means she needs to have her notes read by an interpreter on the patient’s next visit. It is this added difficulty that has led to perhaps one of the most innovative parts of the CAReHR – the ability to provide a translated term for problems. “We had the ability to give people a copy of their record, so we added the facility to include a translated term for problems,”

she says. “Then when you print up the patient summary, if their language matches a translated problem name the translated term displays on the patient summary. “It is a basic start in addressing language barriers, but at least it is a start. Because the system accepts all scripts, in the future, there is the possibility to include more detailed patient instructions and information. I think if you can get a system up and running for vulnerable, non-English speaking people who are recently arrived, you can do it for anyone.” CAReHR is currently integrated with existing scanned hospital medical records, and the hospitals’ cloud-based IT platform, so there is no need to have different systems to access and interrogate different data, no matter where or in what format that data exists. CAReHR can import hospital pathology and administrative data, facilitating single point patient care, and there is potential to link with larger scale hospital electronic records as these become available.

Linking with primary care As one of the driving forces behind the design of the system is to improve information flow, the network always wanted to include the primary care sector as well which is where cdmNet comes in. cdmNet has been designed to create shared care plans that are initiated by the GP, but with input and viewing access for specialists and allied health practitioners. This form of integrated care is particularly important for refugees and newly arrived immigrants who often have complex health needs and who typically see both primary care and specialist providers. Precedence Health Care’s Dr Hibbert has been involved in the project from the start, and had worked briefly with Arcitecta in the past. She is keen on providing patients with

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access to their own information as well as better sharing of information between primary and acute care. “One of the key things we wanted, in addition to the patient having access, was interpreting services,” she says “We are solving a multi-billion dollar problem with a case study in refugee health.” As Arcitecta built the CAReHR system for the hospital clinicians, Precedence continued working in the primary care sector to use care planning to assist with health and issues such as the resettlement issues faced by new immigrants. In many cases, it is not just people’s health issues that need multidisciplinary input, but their social circumstances, housing, education and employment needs as well. “Conditions that are more common in recently arrived refugees would automatically be picked up as a diagnosis within the GP desktop system, so when the patient comes in, you can create a shared record, and have a plan to address these

issues as well as chronic health issues,” Dr Hibbert says. “The bit that was missing was the glue between cdmNet and the hospital.”

developing new treatment guidelines for common issues such as vitamin D deficiency, anaemia, malaria, hepatitis B and tuberculosis.

Within the CAReHR, clinicians are identified with a cdmNet number if they are involved in the care of a particular patient. They can then click through to the cdmNet record and download information from that into the CAReHR. “What the GPs want is to be able to also get all of the information from the hospital Arcitecta system,” she says. “At the moment it is in the form of a summary letter or discharge summary, and that gets downloaded into cdmNet so the GP can also see what has happened in the specialist refugee clinics.

“It is particularly important to get this information quickly as it means we are in a better position to implement preventive health measures, such as screening for malaria soon after people arrive in Australia,” she says. “We can do this based on our assessment of the prevalence of disease from a particular source country, or within a particular patient group.

In addition to disease surveillance and care of patients in both the acute and primary care settings, a lot of the information contained within the CAReHR is incredibly useful for research purposes. RMH’s Professor Biggs says the treatment and research results will be crucial in assessing existing guidelines and

Professor Biggs says the CAReHR speeds up the time from enquiry to insight, leading to more effective patient interventions. “Our ability to capture and securely share data from our clinical and research studies means we can improve the treatment for infectious diseases and other conditions in refugees by making sure all members of the patient’s care team have access to a complete and accurate set of data, across campuses and across the different healthcare systems we use.”

ACSS AAPM P: 1800 196 000 / +61 3 9095 8712 F: +61 3 9329 2524 E: W: The Australian Association of Practice Managers (AAPM) is a not for profit, national peak association founded in 1979, dedicated to supporting effective practice management in the healthcare sector. The Australian Association of Practice Managers: • Represents practice managers and the profession of practice management throughout the healthcare industry. • Promotes professional development and the code of ethics through leadership and education. • Provides specialised services to support quality practice management including advocacy, education, resources, networking, advice and assistance.

ACIVA E: W: 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

P: 1300 788 005 / +61 2 9632 0026 F: +61 2 9632 0096 E: W: ACSS provides innovative and customisable patient management software streamlining day-to-day operations for GPs, Allied Health, Specialists, Radiologists, Pathologists, Private and Public Hospitals. eClaims® — Comprehensive and robust appointment and billing system with digital/voice recognition capabilities, electronic reporting transmissions and HL7 PACS system integration. eClaims® Hybrid — A solution tailored to Hospitals and other health service providers including billing agents who lack online capabilities. eClaims® Hybrid is the interface solution for connecting you to Medicare and health funds through ECLIPSE. SimDay® — Proven PAS (Patient Administration System) specifically designed for day surgeries and private hospitals – Now with ECLIPSE integration.



P: +61 3 5335 2220 F: +61 3 5335 2211 E: W:

P: +61 3 9023 0800 F: +61 3 9614 2650 E: W:

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: W:

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

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: W: 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: • GPCE Melbourne, 15-17 November

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



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

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

Cloud9 Software P: 1300 875 297 F: +61 2 9715 6573 E: W: 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: W: EASIER MEDICAL IT is a technology partnership with DMS – we make IT work for you. DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of all Australian leading medical software applications. DMS is a Business Partner for IBM, LENOVO, HP, CISCO and Microsoft. Other leading ICT brands include Webroot Secure Anywhere, StorageCraft, CA, Toshiba, Canon, Epson, Kyocera, Fujitsu and Brother. Accreditation is easier with the customised DMS IT Systems Policy and Procedures Documentation. This ensures your practice has the best IT policy, security and maintenance program that meets and exceeds the standards guidelines from the RACGP.


Direct CONTROL is the innovative answer to administrative excellence integrating with Microsoft Office, accounting applications, the OOP, clinical applications and Medicare Online. Included are all fee schedules (Medicare, DVA, Work Cover, TAC, CTP, Private Health Insurance) with built in rules relevant to each medical discipline (Allied Health, General Practice, Surgeons, Physicians including Oncology, Anaesthetists, Pathologists, Radiologists, Day Surgeries/Hospitals). Manage Episodes of Care including State, Federal and Health Fund Statistical Reporting for Day Surgeries/ Hospitals. Restructuring work flow with Direct CONTROL guarantees to provide remarkable results, enabling you to grow your business and increase cash flow.

World leading DTech provides 24x7 near Real-Time Monitoring and Management technologies sends alerts and enables our engineers to quickly troubleshoot and remotely solve problems fast of security, network, Internet, server and software on almost any client computer system or device – most are fixed in minutes… Proactive, Flexible, Consistent, Reliable, Audited, and Affordable - for the smallest to the largest practice. Call DMS for: • Systems Analysis, Solutions Design & Consulting • IT Systems Documentation for Accreditation & Compliance • Procurement & supply of leading brand hardware, software, network and peripheral products • Full Installation & Configuration services • On-Site and Remote Technical IT Support • 24x7 IT support Help Desk with extensive medical software expertise • 24x7 DTech Monitoring, Maintenance & Management • Disaster Recovery solutions • Fully managed Online Backup customised for clinical data • Fully managed Internet and Web Security EASIER MEDICAL IT – Call 1300 865 977


P: 1300 557 550 / +61 7 5478 5510 F: +61 7 5478 5520 E: W:

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

Emerging Systems P: +61 2 8853 4700 E: W: 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: W: Extensia links healthcare providers, consumers and their communities for better and more efficient health care. The products used to do this can be custom branded for all Organisations and include: • RecordPoint – a proven Shared Electronic Health Record that links all clinical systems, hospital settings, care plan tools and any other sources of information available. It provides a secure means of sharing critical patient data in a privacy compliant and logical structure. • EPRX – an Electronic Patient Referral Exchange and Directory. It streamlines the process of selecting a provider and completing a referral. Patient information is transferred seamlessly from clinical software. The most relevant providers, services and products are presented instantly and referral documents are generated and sent electronically.

GPA P: 1800 188 088 F: 1800 644 807 E: W: GPA ACCREDITATION plus (GPA) is the only independent accreditation program for general practice in Australia. Established in 1998 and run by a team of committed general practitioners, business leaders and experienced administrators, GPA has developed a program that continuously evolves in order to set new standards in general practice accreditation, while offering full support to practices to make accreditation both achievable and rewarding.

P: +61 2 8985 6688 / 1300 799 904 E: W:

GPA is committed to providing an accreditation program, which is flexible and understands the needs of busy GPs and practice support staff. Whilst accreditation gives practices access to the Practice Incentive Program (PIP), GPA believes it should offer benefits that go well beyond the PIP. Our program provides practices with a pathway to enhanced patient care, continuous professional satisfaction, improved practice efficiency and superior risk management. GPA ACCREDITATION plus certificates and signage remind patients that their practice has achieved a level of care and service above and beyond essential general practice standards.

EpiSoft’s web based platforms deliver dual purpose systems that work as comprehensive clinical and practice management platforms together with clinical trials software facilitating multi-centre investigator initiated trials. EpiSoft has developed platforms for: • Mental Health • Cancer management & surveillance • Inflammatory Bowel Disease • Hepatitis • Indigenous chronic disease management • Asthma shared care • Specialised surgery • Pre-admissions patient portal

GPA provides a system designed to accommodate busy general practices. Among our services, we offer practices the opportunity to use technologicallyadvanced, environmentally-friendly online programs, allowing staff to upload documentation at their own pace; individually assigned client managers, supporting practices through accreditation from start to success and beyond; highly-trained and sensitive surveyors, with extensive experience in all facets of general practice; and interactive training seminars, bringing practices the latest information in standards and innovation.


Affordable and scalable, EpiSoft is used in health organisations ranging from small clinics to large hospital groups across Australia, New Zealand and Singapore. Create multidisciplinary teams, collaborate effortlessly and streamline workflows with our intuitive cloud software. With the highest level of security, redundancy and reliability your data will be accessible anytime and anywhere.

Genie Solutions P: +61 7 3870 4085 F: +61 7 3870 4462 E: W: Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs. Genie runs on both Windows and Mac OS X, or a combination of both. With over 2800 sites, it is now the number one choice of Australian specialists.

At GPA, we believe that accreditation should be an accomplishment, not a test, and we uphold that belief in our approach and service. For an accreditation program that will offer you assistance, support, information and satisfaction…the choice is yours.

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

Health Informatics New Zealand E: W: Health Informatics New Zealand (HINZ) is a national, not-forprofit organisation with a focus on collaboration, education and advocacy for the use of IT in the health sector. HINZ enables professional collaboration through conferences, seminars and an interactive online portal, bringing together clinicians, administrators, allied health professionals and many others with an interest in health IT and the advances it can enable. HINZ provides a platform to share information about the Health Informatics industry - leveraging best practice from New Zealand and overseas, as well as facilitating networking activities to bring industry experts and interested parties together to collaborate. Membership is for anyone with an interest in Health Informatics.



Health Informatics Society of Australia P: +61 3 9326 3311 F: +61 3 8610 0006 E: W: HISA is Australia’s health informatics organisation. We have been supporting and representing Australia’s health informatics and e-health community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for e-health, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics HISA members are part of a national network of people and organisations building a healthcare future enabled by e-health. Join the growing community who are committed to, and passionate about, health reform enabled by e-health.

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

MEDITECH Australia P: +61 2 9901 6400 F: +61 2 9439 6331 E: W: A Worldwide Leader in Health Care Information Systems MEDITECH today stands at the forefront of the health care information systems industry. Our products serve well over 2,300 health care organisations around the world. Large health care enterprises, multi‑hospital alliances, teaching hospitals, community hospitals, rehabilitation and psychiatric chains, long-term care organisations, physicians’ offices, and home care and hospice agencies all use our Health Care Information System to bring integrated care to the populations they serve. Our experience, along with our financial and product stability, assures our customers of a long-term information systems partner to help them achieve their goals.

Medtech Global Ltd P: 1800 148 165 E: W:

Houston Medical

For over 30 years, Medtech Global has been a leading provider of health management solutions to the healthcare industry enabling the comprehensive management of patient information throughout all aspects of the healthcare environment.

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

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



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

Leecare Solutions P: +61 3 9339 6888 F: +61 3 9339 6899 E: W: Leecare Solutions, with their products Platinum 5 & P5 Exec, are the aged care industry’s leading web browser based clinical and management software system. Since 2000, Leecare has provided relevant, contemporary software solutions for Australian and New Zealand aged care organisations. Leecare’s mission and products provide outstanding clinical decision making support, and management support tools that use any device, can be installed on multiple platform types and in any location. Used in over 30,000 aged care places, it is the solution used by quality providers, proven through thousands of accreditation, validation and other regulatory visits, as it is based on professional clinical and lifestyle provision concepts.

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

MIMS Australia P: +61 2 9902 7700 F: +61 2 9902 7701 E: W: MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust. MIMS information is backed by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages. Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base. MIMS is delivered all the ways you need – print to electronic, on the move, to your patient’s bedside or your consulting room desk. Whatever the format, MIMS has the latest information you need.

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

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

MITS:Health P: 1300 700 300 E: W: Managed IT Services for the Health Industry MITS:Health provides a full range of IT services specifically tailored for medical centres, GPs and specialists across Melbourne. • • • • • •

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

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

PicSafe Medi P: +61 3 9670 9339 E: W: The Secure Mobile Medical Imaging System Designed by Australian and US Dermatologists and Plastic Surgeons to be used by a wide range of healthcare professionals working in a variety of clinical settings, PicSafe Medi (patent pending) is as simple as using the normal camera function on your mobile smart device except... your patient’s photo is completely secure and legally compliant in its consent, transmission, and storage when taken with PicSafe... Both iOS and Android compatible, PicSafe Medi simultaneously suffices patient privacy and related government regulatory requirements (including new Federal APP’s, commencing 12th March, 2014) surrounding the capture, use, and storage of medical photographs. Using PicSafe Medi, Healthcare professionals can now quickly connect and efficiently document a patient’s status pictorially, facilitating the medical referral process and, ultimately, improving patient outcomes and satisfaction. Stored clinical photographs are fully patient-consented (including authorisation for specific usages of their photo), watermarked to assure authenticity, and managed in a highly secure, auditable, private server environment, accessible only to authenticated PicSafe users. From the time you take a patient’s photo with a smart device, to the encrypted transmission and secure storage phases of photo handling, the process is seamless and non-intrusive to both photographer and patient. • Increase your efficiency and improve your patients’ clinical outcomes • Remove the worry surrounding costly patient privacy breaches • Assure quick, efficient pictorial documentation of your patient’s status • Facilitate a streamlined medical referral process • Fully document your patient encounters for billing, auditing, and medical-legal purposes PicSafe-Medi is “the missing link” in compliant mobile clinical photography.

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

Professional Transcription Solutions P: 1300 768 476 E: W: 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: W: Shexie is an Australian owned business which has been developing software for medical practices for over 15 years. Our industry and technical knowledge allows us to provide the ultimate ‘easy to use’, ‘fully functioned’ and ‘robust’ product on the market. Shexie Medical System clinical and practice management software is ideal for surgical or specialist practices of any size. Many fully integrated features including Paperless Office, SMS, full Paperless Electronic Claiming including Eclipse, MIMS Integrated, statistical analysis, security, synchronize appointments with Outlook/PDAs, transcription interface, diagnostic equipment interface, automated MBS/Fund rates updates. Soon to be released Shexie Platinum version also contains eHealth - Health Identifiers, PCEHR and Secure Messaging.

Sysmex P: +61 3 9013 4445 E: W: Sysmex is dedicated solely to helping your healthcare organisation achieve more in less time, with fewer errors and better patient outcomes. Sysmex leads the way in eDiagnostics: • Providing an essential building block for the electronic medical record with the Eclair Clinical Information System • Enabling sharing of key patient information across regions through the Eclair Clinical Data Repository • Completing the electronic loop with laboratory and radiology order request management (CPOE) • Streamlining all areas of the anatomical pathology laboratory workflow from request to report with Delphic AP • Improving reporting times and reducing costs through an enterprise Delphic LIS, shared across multiple laboratories

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



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

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

Therapeutic Guidelines Ltd P: 1800 061 260 E: W: Therapeutic Guidelines Limited is an independent not-for-profit organisation dedicated to deriving guidelines for therapy from the latest world literature, interpreted and distilled by Australia’s most eminent and respected experts. These experts, with many years of clinical experience, work with skilled medical editors to sift and sort through research data, systematic reviews, local protocols and other sources of information, to ensure that the clear and practical recommendations developed are based on the best available evidence.


VConsult P: 1300 82 66 78 F: 1300 66 10 66 E: W: VConsult offers outsourced practice management solutions for medical and allied health practitioners allowing the focus to be on your professional practice and patient care. VConsult provides a seamless “behind the scenes” service by professionally managing your telephone calls, reception, invoicing and medical transcription requirements.

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.

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.

It provides access to over 3000 clinical topics, relevant PBS, pregnancy and breastfeeding information, key references, and other independent information such as Australian Prescriber (including Medicines Safety Update), NPS Radar, NPS News and Cochrane Reviews.


eTG complete is available in a range of convenient formats – online access, online download, CD, and intranet access for hospitals. Multi-user licences, ideal for a practice or clinic, are also available. It is widely used by practitioners and pharmacists in community and hospital settings in all Australian states and territories. The November 2013 release of eTG complete includes updates of key Endocrinology topics, including diabetes, thyroid disorders, and endocrine disorders and pregnancy. 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: 1300 933 000 F: +61 3 9284 3399 E: W: Zedmed is an innovative provider of business solutions to the medical and financial services industries. Our practice and clinical management solution is designed to be simple, intuitive and seamlessly integrated. With personalised training, installation and data conversions from almost all software packages, changing software has never been so easy. Zedmed would also like to introduce to you Medical Record Exchange – a free, simple solution allowing Doctors to send patient’s medical information to insurance companies electronically. Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis. For more information about Medical Record Exchange, please contact us: Phone: 1300 933 833

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Sterilisation - Part 2

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Pulse+IT Magazine - November 2013  

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

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