Australasia’s First and Only eHealth and Health IT Magazine
7 OCTOBER 2013
Online appointment systems
Is your practice ready to accept bookings via the Internet? Pulse+IT takes a look at some of the options.
Extending your clinical software Pulse+IT profiles a range of solutions that work with your clinical software to deliver additional functionality.
PCEHR resources guide Having trouble setting up or using the PCEHR? Pulse+IT’s overview of quality resources can assist.
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Looking Ahead Pulse+IT welcomes feature articles and guest editorial submissions relating to the nominated edition themes, as well as articles relating to eHealth and Health IT more broadly. In addition to our daily eNewsletter service, Pulse+IT is produced in print seven times per year with the remaining edition for 2013 to be distributed for release in: • Mid-November 2013 - mHealth Proposed edition themes for 2014 will be announced in November.
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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 Nigel Chartres, Simon James, Jonathan Lee, Kate McDonald and Geoffrey Sayer. 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.
A SYNOPSIS OF HIC2013
STARTUP In search of clues for what is in store for eHealth, Simon James revisits the writings of former health minister, now Prime Minister, Tony Abbott.
GEOFFREY SAYER With the advent of a new government, it is timely to look back on the last three years to consider how many of the building blocks of eHealth have fared.
HISA HIC 2013 set out to focus on the significant opportunities that information technologies are fostering throughout the health sector.
Up and coming eHealth, Health, and IT events.
PULSE+IT DIRECTORY The Pulse+IT Directory profiles Australasia’s most innovative and influential eHealth and Health IT organisations.
ONLINE APPOINTMENTS Thinking of trying out an online appointment booking service? Pulse+IT provides practices with an overview of what to consider.
SELECTED BITS & BYTES NEHTA reveals PCEHR and eHealth uptake data Northern Territory pushes for its pathology model for PCEHR
PATIENT ASSISTANCE TOOL Dr Pat Byrnes’ Patient Assistance Tool (PAT) can automatically generate GP management plans for chronic diseases.
Pharmacy Guild takes a wait and see approach to PCEHR
THE DOCTORS CONTROL PANEL
South West Alliance ramps up eHealth rollout
Dr Anton Knieriemen’s popular software utility has evolved to allow doctors to share pathology results with patients over the Internet.
MD SIDEBAR HCN will soon release its much anticipated Medical Director Sidebar and associated widget store. Pulse+IT takes a look.
JONATHAN LEE The humble telephone might not be considered high-tech, but telephone systems have always been critical practice infrastructure.
PCEHR RESOURCES After a slow start, there is now a multitude of information available on registering for the PCEHR.
UQ telehealth funding boost
cdmNet can help improve clinical outcomes in diabetes care iPhone app with ECG a candidate for mass AF screening Telstra buys DCA’s healthcare division SA hospitals sending discharge summaries to PCEHR Anywhere Healthcare adds to specialist panel for national roll-out ACT and Queensland hospitals go paperless in ICU EpiSoft to launch Cancer CareZone
BACK TO THE FUTURE With the PCEHR failing to attract any meaningful interest, much less any meaningful use, the new federal government has undertaken to review the status of the project and broader eHealth landscape. With a chorus of stakeholders lining up to provide advice to the new government, Pulse+IT looks to the past for guidance to what the future may hold.
SIMON JAMES BIT, BComm Editor: Pulse+IT firstname.lastname@example.org
In the very first edition of Pulse+IT, released in August 2006, the then Health Minister Tony Abbott outlined the government’s eHealth objectives. In addition to a range of improvements relating to payments and claiming, Mr Abbott listed the “fourth, and most important” objective as follows: “To ensure that every significant health record is available in a digestible form to every patient and, with patient authorisation, to any treating health professional.” Seven years have since passed, and while the ambitious goal of providing every patient with such a record has not yet been realised, the basic functionality Mr Abbott described in 2006 is at least now recognisable in the PCEHR.
About the author
He went on to outline some of the benefits such a health record system would deliver, claims that have been often repeated by successive health ministers in the intervening years since Mr Abbott’s editorial was written.
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.
“An integrated health record could prevent some of the estimated 3500 avoidable deaths a year in hospitals due to inadequate record keeping and incomplete information. Online access could avoid repetitive radiology and pathology tests
and save a significant part of the $3 billion a year spent on diagnostics.” While few details are yet to emerge, it is worth noting that $8m has recently been allocated to deliver diagnostic results to the PCEHR. In 2006, NEHTA had only recently commenced operations, with Mr Abbott highlighting individual health identifiers for patients and providers, and medical terminologies initiatives as priorities for the “next three years”. With NEHTA’s current funding commitments ending in June 2014, it remains to be seen whether the organisation will exist long enough to see its terminology work come to fruition. However, perhaps the best guidance to the new government’s plans for eHealth can be divined from Mr Abbott’s closing remarks: “As minister, I will do everything I can to create a benign environment but it’s mostly up to the private market to develop the systems and the medical profession to use them if Australia’s health care is to remain second-to-none. Government can’t be the great provider but it should be the great facilitator, so the private sector can deliver e-health solutions.”
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THE WORLD MOVES ON As a new government starts to exert control of the Australian eHealth system, it is timely to look back on the last three years to consider how many of the building blocks of eHealth have fared. Secure message delivery is showing potential, but there are precious few other successes to speak of. Perhaps it is time to take a more pragmatic approach.
DR GEOFFREY SAYER BSc(Psychol), MCH, PhD Head of Operations, HealthLink email@example.com
I haven’t written for Pulse+IT for a couple of years, as I’ve been spending my time in the obscurity of industry after serving time as president of the Medical Software Industry Association for two years. Since that time, some things have changed and some things have remained the same. In an article from 2010, I wrote: “The (recent) budget initiative for Personally Controlled Electronic Healthcare Records (PCEHR) has two years to demonstrate benefits of PCEHR, but there is a longer time table to deliver the actual building blocks that will underpin the initiative”.
About the author
Since then, the PCEHR has come and politicians have gone. Many of the top public servants in DoHA, Medicare Australia and NEHTA have changed as well. “Cash for comment” commentators have gone. There have been high profile doctors walking away from the cause despite being willingly on board for many years. The marketing spin of ‘how great eHealth will be’ changed to ‘how great it would be if only you were registered for a PCEHR’.
Geoffrey is head of operations for HealthLink. For over 12 years, Geoffrey has occupied senior management positions in medical software companies in Australia and New Zealand. He is a past president of the MSIA and has 22 years’ experience working as an epidemiologist.
There has been taxpayers’ money plastered on to buses, eHealth travelling road shows, Medicare Locals funded to drive change in markets worth less than what their allocated funding is and squadrons of recruiters working hospitals
over, bailing up would-be beneficiaries of health information available anywhere – anytime. It seems that hanging onto the dream of a centralised repository is vanishing from the memory. One feels that we maybe waking from a fitful dream, waking to the world that is moving on regardless of the ambitions of dreamers. NEHTA was established under Tony Abbott’s reign as health minister many years ago, but it seems that many no longer see NEHTA’s relevance. Countless consultants paid well and well-travelled are now telling us what we should have done. Companies that have cashed in on the largess of the taxpayers’ purse have disappeared from our radars or apparently lost interest. Neck deep in the hype of the day, ankle deep in commitment it seems, toes not touching the waters of outcomes or efficiencies. It is not surprising that interest levels for these organisations are no longer viable when the project money runs out. When you run a project-based business you are not incentivised to hang in there or able to establish a go-forward, sustainable business model. When the forecasted outcomes are not happening till sometime in the future, it is easier justifying return of initial investments
against unaccountable checkpoints in some unforeseen time. What remains are the people who were there before the craziness started – vendors who have business models and longer term commitments beyond the political cycles. Unfortunately, the sustainable value that vendors have created has little to do with the PCEHR. I consider myself fortunate to work for a company that has always been interested in the practical side of information exchange: point to point messaging with general practice as the focal point of the healthcare system. The view is a simple one – GPs play a fundamental role in the providence of the patient record. However, if we are to achieve interconnection and interoperability, we must have timely delivering of capability across all sectors; well specified requirements; use of standards supported by industry; robust testing and infrastructure capabilities; appropriate levels of conformance, compliance and accreditation (CCA); effective support and education of end users; and appropriate business and financial drivers. As I have argued for many years, a PCEHR would be a by-product of successful implementation of the building blocks that NEHTA espoused for many years. One can’t be completely dismissive of some successes of recent times. CCA is a key part of software implementations looking to achieve interoperability, especially for large rollouts in health. The recent effort on CCA around SMD and CDA medical document management (MDM) places us in good stead for the future for information exchange, as many GP vendors were supported to create a common payload for SMD. Unfortunately, the stakes have been high and some companies were unable to stay in the game as code was written and re-written. Lots of money has been thrown at eHealth, but once the dust
“NEHTA was established under Tony Abbott’s reign as health minister many years ago, but it seems that many no longer see NEHTA’s relevance.” Dr Geoffrey Sayer
is settled, what are the drivers to keep the show on the road? It is still important to look at initiatives that focus on the inter-sectorial points – GP and pharmacy, GP and pathology, GP and radiology, GP and specialists, GP and hospitals, GP and healthcare organisations – as these are the connecting points where patients are crossing over the boundaries of care. Creating value will be fundamental if we are to progress the level and depth of information exchange. The money from government will be put on hold under new leadership or dry up altogether. While there will be focused PIP programs for GPs that may drive uptake of eHealth building blocks and SMD capability, we need the ability to send to non-GPs if we are to improve the transfer of care and benefits of electronic information exchange. Furthermore, we will need to look at the problems that face the interchange of information: better referral processes, diagnostic ordering, enabling of end points to be able to send and receive patient information. I believe this can be achieved through industry leadership rather than government management processes. Leadership is different from management in that it inspires. Leadership is effective problem-solving that uses problem‑solving as part of the engagement process. Leadership focuses on outcomes and
strategies about how to get there with effective planning and consideration. Leadership finds ways that no one else has thought of. In the last article I wrote for Pulse+IT in 2011, I concluded with this statement: “For if we don’t engage the wider industry now they will have wandered off and will pursue things that really matter. eHealth dreams will be remembered as lost opportunities, and good money after bad again, like the ghosts of eHealth past.” I think industry has already moved on and is getting back to business – creating value that funders and end users are prepared to pay for. If the rollout of the PCEHR program relied on vendors being responsible for the implementation to their end users, the take-up numbers by practices would have been much higher for much less money. The same rationale would have also applied to secure messaging. The money given to Medicare Locals to assist in uptake is arguably more than the current market value for all the secure messaging companies in the space. Invariably, the vendors are doing key stages and are not well positioned to charge the end user for the true cost of the service. Under this approach for rolling things out, there are no big bangs. No blank cheques. No spin doctoring. Only payment for services rendered and outcomes delivered. It seems I haven’t changed my view at all and the world moves on regardless.
NEHTA reveals PCEHR and eHealth uptake data in public report card
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The National E-Health Transition Authority (NEHTA) has released a scorecard showing the adoption of the PCEHR and other eHealth foundations amongst general practice, community pharmacy, aged and acute care and the wider community.
Software with secure message delivery (SMD) capability has been deployed to 38 general practices along with two specialist and three allied health practices, although this is understood to have increased significantly due to the ePIP.
The scorecard data is limited to information available to NEHTA and is only available up to July. It is the first time that NEHTA has publicly released this information since the PCEHR project began.
NEHTA only has data on shared health summary uploads up to July 31, of 4585. Pulse+IT understands this is now well over the 5000 mark.
The scorecard covers readiness, adoption and “meaningful use” data for general practice, community pharmacy and consumers.
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The data shows that as at July 10, there were 3723 general practices registered in the PCEHR system, which NEHTA says covers an estimated 53 per cent of total general practices in Australia.
NEHTA has devised a graph showing which types of healthcare organisations have registered in the PCEHR system up to July 10, including: • 72 Aboriginal Medical Services • 7 aged care facilities • 47 allied health organisations • 70 community health centres • 271 community pharmacies • 3723 general practices
• 50 Medicare Local/ State/Territory or Area Health Services • 3 private hospitals • 8 public hospitals • 73 specialists • 175 other or unknown The report states that activity in the community pharmacy sector remains “at a moderate level”. Two pharmacy software vendors – Fred IT and Simple – have released PCEHRcompatible systems, which NEHTA estimates covers about 65 per cent of the market. The majority of the pharmacies registered in the system are those taking part in the Medview/ National Prescription and Dispense Repository (NPDR) project. The figures show that as at July 31, 6640 dispense notifications were uploaded to the NPDR. As the Pharmacy Guild has advised pharmacies not involved in the Wave 1 and 2 sites against signing the
participation agreement until systems are in place to allow individual users to be identified (see page 14), pharmacy uptake of is still quite low. NEHTA’s figures show that the volume of ePrescriptions being downloaded from the two prescription exchange services, eRx and MediSecure, are trending up, although not at the volume that they are being uploaded by GPs. In May, for example, about 6.5 million prescriptions were uploaded but just over one million were downloaded by pharmacists. In terms of the acute care sector, the figures show
that as of July 31, 701 discharge summaries had been uploaded to the PCEHR, the vast bulk of them from St Vincent’s Hospital in Sydney. The others came from Calvary Hospital in the ACT and from public hospitals in South Australia. In terms of consumers registering for the system, NEHTA’s figures of 612,391 have since been superseded. It is understood that close to a million people are now registered. Over 5000 people have downloaded the Child eHealth Record (CeHR) app since it was launched in June, with over 1750 CeHR documents uploaded. “Meaningful use by
consumers appears to remain at a low level, and detailed data is not yet available to NEHTA.“ The number of people using the consumer portal lags the total number of registrations, indicating that not all consumers are interacting with the PCEHR after they have registered. “By comparison, the frequency of accessing via the mobile gateway, which has been accessed 81,733 times since 12 May 2013, is very high relative to the number of CeHR apps that have been downloaded. “This would seem to indicate that the mobile channel is capable of driving relatively high engagement.”
More incentive for pharmacies to take up ETP Community pharmacies can receive up to $2000 per outlet under a new electronic prescription scanning incentive (ePSI) negotiated between the Pharmacy Guild and the Department of Health. The incentive will be funded through a reallocation of existing electronic transfer of prescriptions (ETP) funding within the 5th Community Pharmacy Agreement (5CPA) and will therefore be cost neutral. To qualify for the ePSI, pharmacies will need to meet or exceed specified ETP scan rates over two review periods, with a rate of 15 per cent of all original prescriptions by November 2013 the first target. Pharmacies also need to be eligible for the Pharmacy Practice Incentive (PPI) Community Services Support priority area. This priority area includes five elements: the needle and syringe program, opioid substitution program, return of unwanted medicines (RUM), staff training or eHealth. eHealth in community pharmacy includes the use of appropriate dispensing software, broadband internet connectivity, PBS Online claiming and the use of an electronic prescription exchange service. One of the requirements under the 5CPA is that community pharmacies will also use and contribute to the PCEHR in the future. Pharmacy Guild national president Kos Sclavos said the incentive was an important step in supporting community pharmacy’s role in improving the use of medicines and reducing the number of adverse medication events by embedding ETP into practice. “This is a significant and cost-effective step towards boosting the use of electronic prescription technology, reaping tangible benefits in terms of accuracy, efficiency and medication management,” he said.
Bits & Bytes
iCareHealth uploads first event summary to PCEHR Melbourne-based mecwacare has become the first aged care provider to upload an event summary to the PCEHR, using iCareHealth’s clinical and care management software. iCareHealth understands it is the first member of NEHTA’s aged care software panel to successfully upload an event summary to the system. Event summaries are clinical documents written in narrative form that describe an event a clinician deems relevant to the care of a person. They can be submitted to the PCEHR by any participating organisation. iCareHealth has been working with three aged care providers in Melbourne to deploy its PCEHR-compliant software since the panel was established last year. Five aged care software vendors are now PCEHRcompliant. iCareHealth managing director Chris Gray said he hoped mecwacare’s experience would encourage other aged care organisations to take the steps to prepare for eHealth. “The implementation of electronic health records is a critical component of using technology to help manage the increasing demands on our health and aged care systems,” Mr Gray said. “Electronic records will enable care providers to electronically share vital information with providers in the wider health care network including GPs, pharmacies, hospitals, specialists and other care professionals. “The most up-to-date information about a resident will be available online from facility admission, to a hospital transfer and discharge, or to a visit with a specialist, and back to the facility again.”
Northern Territory pushes for its pathology model for PCEHR The Northern Territory Department of Health is hoping that its model for posting pathology results and diagnostic imaging reports to the My eHealth Record (MeHR) will be adopted in the short term for the national PCEHR.
the Northern Territory Department of Health, told the eHealth Interoperability Conference in Sydney in September that her team hoped the method currently being used for the Territory’s MeHR would be chosen.
Debate has raged around what is the best method to post pathology results and diagnostic reports to the PCEHR following the announcement in July by former health minister Tanya Plibersek that $8 million would be allocated to designing a suitable system.
Ms McAnelly said NEHTA and the Department of Health and Ageing (DoHA) were planning to have pathology and DI ready for the PCEHR by next April, when the fifth release of the national system was due to be rolled out.
Both the private pathology sector and the Royal College of Pathologists of Australasia (RCPA) have voiced concerns over the safety ramifications of some of the proposed methods. The RCPA in particular is concerned about the ramifications of atomic data from test results being separated from the pathologist’s full report and interpretation. RCPA president Yee Khong said the college preferred a method in which the whole report was posted as an individual document. However, industry sources say that method is very unlikely to be agreed to. Sharon McAnelly, director of eHealth systems with
“For the NT this is quite challenging, because we had a reliable, trustworthy system that our clinicians and our consumers were very happy with.” The NT is working on what it calls the M2N project, in which the MeHR (M) will be rolled into the national PCEHR (N) by that date. The NT is planning to go live with its combined system on April 28, two weeks after release five of the PCEHR is due. “These are critical documents for our transition project,”
Ms McAnelly said. “At the moment, the model is that the pathology results come into the inbox, the clinician witnesses those results, they make a decision about consent and they post them to the MeHR. “We want to take that strategy forward as a temporary strategy for the PCEHR. I think that in the long term it would make perfect sense if they came straight from pathology companies, but the transition strategy for us is that they come into our clinical information systems and we provide the authority to post them by witnessing them, and then we pump them to the MeHR. “This is still under consultation so it’s not a decision, but we are hoping to move that to the PCEHR. I don’t see that as a longterm model. The model that they are discussing is that it still comes to the clinician’s inbox, but they then send an authority to post to the pathology company, and the pathology company can then post. All of that is still under consultation.” Ms McAnelly said one of the major challenges of the M2N project was resistance from users of the MeHR to moving to the national system. “For the NT this is quite challenging, because we had a reliable,
trustworthy system that our clinicians and our consumers were very happy with. I remember going to a meeting and someone saying ‘the PCEHR doesn’t have enough information for our needs, our system is better and we are not moving.’ “What we worked towards to overcome any resistance from our clinicians moving from the MeHR to the PCEHR was to make sure that what was sent to the two repositories was the same, and it is, so we are very dependent on getting the pathology results and diagnostic imaging reports.” Ms McAnelly said there were approximately 60,000 patients with an MeHR, predominantly indigenous people in the NT, northern South Australia and the
Kimberley region. There are 9000 authorised clinical users across 130 sites, and the most recent figures show that 1000 clinicians were accessing the MeHR per month, with about 42,400 views per month. “Since we started in 2005 up to the current year, views increased quite rapidly in about 2009-10 and have continued. “If we compare that with what we expect to see with the PCEHR, it won’t be 10 years, it will be more like four or five. Getting the documents up there, that is the pot of gold.” The NT has not yet managed to begin sending discharge summaries to the PCEHR, but was hoping to use the Healthcare Information and PCEHR Services (HIPS) technology
designed by the South Australian government.
Cloud9 enters acute care sector with Clarity
Ms McAnelly said HIPS was able to simplify some of the interactions with the PCEHR particularly for the acute care sector. SA Health is using HIPS to send discharge summaries to the PCEHR from nine of its public hospitals.
Sydney-based enterprise healthcare solutions vendor Cloud9 Software has entered into a strategic merger with Indian hospital information systems provider IdeaObject.
David Bunker, NEHTA’s head of architecture, told the conference he planned to make the HIPS source code available “as it is a good way to link to the national infrastructure and is relatively simple”. Ms McAnelly said the NT’s plans to go live with its merged MeHR/PCEHR were dependent on NEHTA and the Department of Health getting pathology results and diagnostic imaging live on those dates.
C9, which markets the Clarity primary care clinical information system as well as the Monet system it bought from iSOFT in 2010, will target private hospitals and day surgery groups with the new offering. In addition to the Monet and Clarity primary care packages, C9 offers a health information exchange system called Clarity Spine and an integration engine called Synchronicity. IdeaObject has over 300 installations around the world. C9 CEO Marc Goldman said the merged entity will be called Cloud9 and all products will be distributed under the C9 brand. Mr Goldman said IdeaObject has product suites that provide a comprehensive healthcare solution with integration capabilities that will give C9 “a fundamental foundation for the C9 HIS platform”. “Given the platform is cloud-enabled we are looking at a new, more cost-effective model for those organisations that may want to manage the cost more effectively,” he said. “That market is really underserviced at the moment.” Mr Goldman said Monet, which is used in medical centres across Australia, would continue to be supported until sites moved over to Clarity. “At the moment we are busy upgrading our Monet sites to Clarity. This will take us some time to complete. In the meantime we will continue to support Monet and will give our sites significant notice prior to discontinuing support for Monet.”
Bits & Bytes
Apps4Broadband competition gives apps a little PEP The Australian Centre for Broadband Innovation (ACBI) has released a guide to broadband-connected services outlining how apps and remote monitoring will enable new services to be offered in health and aged care. The ACBI’s App-trepreneur’s Guide to Broadband Connected Services report uses case studies from the recent Apps4Broadband competition, which saw $65,000 in prize money awarded to innovative app ideas. Amongst the highly commended apps in the competition were RemoteMinder, a low cost movement monitoring system for inhome aged care; Faller, a platform which monitors falls via a telepresence service for the elderly using wearable devices; and Care for Me, a simple activity monitoring system for in-home aged care. The joint winner of the best health, education or social services app was Pepster, a home-based breathing exercise app and device for cystic fibrosis patients. Developed by Brisbane-based start-up company HSK Instruments, Pepster assists in respiratory physiotherapy for cystic fibrosis patients. It consists of a piece of hardware called Acquisition that collects respiratory data during positive expiratory pressure (PEP) therapy and sends it in real time to an associated tablet or phone device with Pepster Apps. 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.
Pharmacy Guild takes a wait and see approach to taking part in PCEHR The Pharmacy Guild of Australia has clarified its position on community pharmacy involvement in the PCEHR, saying that while a concern over legal risks to pharmacists using the system had been overcome, it would wait to review its position until the outcome of the new government’s audit of the system was known. In a scorecard on PCEHR and eHealth uptake, NEHTA recently reported that it understood that the Pharmacy Guild had advised members not to sign the PCEHR participation agreement until systems were in place to allow individual users to be identified. NEHTA said uptake amongst pharmacists outside the lead eHealth sites was being hampered by difficulties in identifying individual users of common pharmacy terminals, which is a requirement of participating in the PCEHR. NEHTA’s figures show that as of July 10, 271 community pharmacies were registered in the PCEHR system, but most of those were in Tasmania, Victoria or Queensland and were involved in the Medview trial, which established the National Prescription and Dispense Repository (NPDR) that is now live on the PCEHR.
In a statement to Pulse+IT, a spokesperson for the Guild said the legal risks had been “largely overcome”, but the organisation would not review its recommendation against signing the agreement until the new government announced what it planned to do.
“We welcome and support the direction of the incoming Coalition government where a focus will be on electronic prescriptions and medication management.” “The Pharmacy Guild of Australia supports the concept of an electronic health record and has invested significant time and financial resources to see such a system become a reality,” the spokesperson said. “The federal election has just concluded and one significant area of policy difference between the major parties is in the area of eHealth. We welcome and support the direction of the incoming Coalition government
where a focus will be on electronic prescriptions and medication management. “However the Coalition has announced they will undertake an audit of the current [PCEHR system] and we wait to see the outcomes of the new government’s audit and the subsequent policy changes before we review our position.” The spokesperson said the technical ability now exists for pharmacies to participate in the PCEHR. “We now however have an audit which could result in changes to the PCEHR and the role of community pharmacy. Our members need a clear path on the future of the system and at present there are many unknowns.” Industry sources have told Pulse+IT that the main concerns for pharmacists were legal and workflow issues. Unlike most general practitioners, pharmacists can use a number of terminals during their working day and share those terminals with other pharmacists, and logging in and out constantly was not practical. This posed a legal risk to pharmacists as it is a requirement of the system that healthcare providers who view, upload
or download information must be identified through their Healthcare Provider Identifier – Individual (HPI-I) number. Pulse+IT understands that a password system with additional linking of HPI-Is to the individual’s initials has now been created so that pharmacists can use and share multiple terminals with other pharmacists. The Guild spokesperson said the organisation was committed to continuing to support innovation in eHealth through technology-enabled medication management
solutions such as electronic transfer of prescriptions (ETP) and the NPDR. The Guild has negotiated a new Electronic Prescription Scanning Incentive (ePSI) with the Department of Health and Ageing, which it said was developed with the input and full knowledge of the incoming government. “We are waiting to meet with the Health Minister and other ministers responsible for eHealth and other health programs to progress these medication management initiatives and discuss how pharmacy can support the outcomes of the PCEHR audit.”
The spokesperson said funding for the ePSI, which can net pharmacies up to $2000 for scanning a certain percentage of all scripts, was part of the original Fifth Community Pharmacy Agreement (5CPA) funding, which pays for the 15 cent fee for scanned original scripts. “The expenditure of this money was below budget in the first two years of the Agreement because of slow uptake by doctors and because the 15 cents was payable only for original electronic scripts and repeats – not repeats where the original was not electronic.”
UQ telehealth receives funding boost A University of Queenslandled consortium has been awarded a National Health and Medical Research Council (NHMRC) grant of $2.5 million to bring together a team of telehealth researchers into a new Centre of Research Excellence in Telehealth. The CRE in Telehealth will bring together four telehealth research groups from UQ – the Centre for Online Health, the Centre for Research in Geriatric Medicine, the Telerehabilitation Research Unit and the Dermatology Research Centre – along with researchers from Brisbane’s Inala Indigenous
Health Service, Griffith University and UQ’s School of Business.
increase the cohort of telehealth researchers and practitioners.
Led by well-known telehealth researcher and geriatrician Len Gray, who is also head of the centres for online health and research in geriatric medicine, the new CRE in Telehealth will be supported by technical experts in health economics, IT, engineering, health informatics, workforce planning and management.
“The CRE in Telehealth will focus on health service settings where access is currently challenging, such as small rural hospitals, residential aged care facilities, people’s homes (particularly for disabled and older people), and indigenous communities,” he said.
Professor Gray said the centre aimed to accelerate telehealth research into healthcare delivery and
“The telehealth team has extensive research and translation experience in telemedicine in paediatrics, geriatrics, speech pathology, physiotherapy and dermatology.”
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eHealth applications score high at iAwards The Integrative Medicine Gateway that has been integrated into eMIMS to provide information on complementary and prescription drug interactions won the health category at the national iAwards, held in Melbourne in August. The IMgateway was developed by UnityHealth to provide evidence-based information on complementary medicines. Last year, a drug-herb interaction module was added to MIMS’ electronic service, allowing users to select complementary and prescription medications from a list to analyse their interactions. Two health IT projects were given merit awards, including the NT Department of Health and SRA Technology for their internet protocol patient monitor security access and reporting system (ISARS), which provides remote patients with access to specialist clinicians. The Australian e-Health Research Centre (AEHRC) site in WA, which concentrates on ocular diseases, won a merit award in the health category for its automated system of disease grading and clinical decision support for diabetes-related eye disease. It also won a merit award in the research and development category for its computer-aided ocular biomarker suite for early detection of Alzheimer’s disease. The AEHRC’s Queensland operations won a merit award in the community category for its Safer Smarter Homes platform. Jose Alvarado and his teammates from Edith Cowan University won the undergraduate tertiary student award for their Parkinson’s iTest app, which is designed to work on iPads and other tablet devices to test the condition of a patient with Parkinson’s disease and share the results with their neurologist in the cloud. The team hopes to have an updated app available for early trials out shortly.
South West Alliance of Rural Health ramps up eHealth roll-out for Victoria Victoria’s South West Alliance of Rural Health (SWARH) has installed a new patient administration system in 10 of its hospitals, based on InterSystems’ TrakCare web-based technology. TrakCare is also used as the clinical information system in most of the member hospitals in the alliance. SWARH CIO Garry Druitt said that by implementing the patient administration module of TrakCare, SWARH will have the power to do more with its electronic health record. “We are working with InterSystems to implement new clinical functionality over the next six months, with electronic medication
management and support for new national quality standards for clinical care at the top of the list,” Mr Druitt said. Plans are also afoot to install InterSystems’ TrakCare Analytics and Community Health functionality, he said. “When we implement TrakCare Analytics, we will be able to access administrative as well as clinical information to analyse things like public health outcomes, operating theatre usage, or accuracy of diagnoses based on a set of clinical observations.” SWARH members include Barwon Health, which operates Geelong Hospital and a large aged care
service, along with regional health services that operate base hospitals at Warrnambool, Hamilton, Colac and Portland and smaller acute care facilities. It also includes several bush nursing centres and sub-acute, primary, community and aged care services through several rural health organisations. Most of the hospitals have used TrakCare as the clinical information system for a number of years, while Geelong Hospital, Lorne and Winchelsea use CSC’s i.PM and Core Medical Solutions’ BOSSnet. Last decade, SWARH designed a secure broadband connection to provide unified
communications across its hospitals and clinics using microwave broadband technology that has since switched over to an Ethernet-based microwave broadband network. The technology is now capable of delivering speeds of up to 100 Mbps into every SWARH facility, with 500 Mpbs capacity across the network. The alliance runs its own wide area network (WAN), developed by SWARH with the assistance of Dimension Data and Cisco, which allowed it to move to an IP-based telephone system way back in 2000. SWARH began a virtualisation exercise in 2011, using Cisco’s VXI virtualisation experience infrastructure, and it is using the WAN to continue to develop more services for clinicians, including the rollout of thin client technology to replace traditional hospital workstations. Mr Druitt said it is also encouraging a BYOD philosophy, using Citrix’s Receiver technology so clinicians can use their own devices running on any operating system to connect to the SWARH network and access its applications. “With a resilient network our philosophy is to invest in our network and centralise and that will pay for itself,” he said.
“We have a target of about 4000 devices. We are up to about 1000 and the performance is much better. It doesn’t matter what operating system you use, and there’s no security issues.”
“My vision is that you can bring in any smart device that you want to, and it’s your own device.” Mr Druitt said external clinicians are able to bring in their smartphone and download the Citrix Receiver, and then connect to the SWARH network. “It creates a window within your operating system through which you can use our applications, and when you disconnect from us it all goes. “My vision is that you can bring in any smart device that you want to, and it’s your own device. You just plug it into a screen and a bluetooth keyboard and you are off, and when you go home you have remote access in the same way. Then it becomes completely agnostic to where you are working. “For most of the region there is a standard look and feel that is delivered virtually on a thin client and they can access it where they want.”
It is also opening telehealth and telemedicine capability to offsite clinicians, including some GP clinics that SWARH services, he said. “We do have GP clinics as customers of SWARH, and those that are connected to our network don’t have a problem, but for those that are not connected we do have telemedicine available. “You can register with us and download one of our clients from the internet, and that means that you can use your workstation as a video unit for telemedicine to connect internally to any of our devices. That is currently available.” “We also have doctors connected at their home via 3G to the emergency department at Geelong. We are doing quite a lot of things with external people using 3G technology and our own network.” Mr Druitt said Barwon Health was currently looking at how best to create a model for discharge summaries to send to GPs and the PCEHR. He said the use of Individual Healthcare Identifiers was key. “You’ve got to be able to identify that this is the patient you are talking about before you start making these things available. Once we have that unique identifier we can start making that happen through the PCEHR.”
HealthLink passes SMD commissioning milestone Secure messaging provider HealthLink has announced it has commissioned over 1000 general practices to use its SMDcompatible offering. Having a secure messaging solution with the SMD protocol commissioned is one of the requirements of the current eHealth Practice Incentives Program (ePIP). The ‘commissioning’ process refers to a series of technical and administrative steps that practices and their secure messaging provider need to undertake to ensure their messaging software is updated and configured to interconnect with other healthcare organisations using the SMD protocol. Nikki Breslin, HealthLink’s national eHealth manager, said the organisation had over 2500 general practices on its SMD commissioning register, and is working towards having these practices operational before the deadline, which was recently extended to October 31. “Many practices are still trying to make sense of their requirements or have made late applications for healthcare identifiers and NASH certificates,” Ms Breslin said. She said that due to the scale of the project and its relevance to the ePIP, the organisation was seeing an increased awareness and expectation amongst healthcare providers to exchange information as practices are keen to make use of their new capabilities. “We are receiving more calls from allied health, specialists and other community organisations who want to participate or are being encouraged to by GPs,” she said. “Healthcare facilities and hospital are also preparing and seeking our assistance to either transition their existing methods or to start using SMD.”
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Queensland to build telehealth network The Queensland government has announced seven evaluation sites for its promised Rural Telehealth Service, which it says will use existing and underused infrastructure to improve telehealth provision to people in rural and remote areas of the state. The towns of Alpha, Eidsvold, Moura, Kowanyama, Normanton, Roma and Bedourie have been chosen as the evaluation sites for the expansion of the $30 million project, funding for which was announced in the June budget. The government promised the new service in its February Blueprint for better healthcare in Queensland, with the funding to be spread over four years. The blueprint stated that a network of telehealth facilities would be developed, expanded and coordinated to bring remote residents straight into the waiting room of the most advanced hospitals in the state. “Under the Rural Telehealth Service facilities in different communities will be standardised, upgraded or re-orientated to enable networking at-call,” the blueprint stated. “As the scope and scalability of the new facilities is developed, training and workplace arrangements will enable local emergency access for patients at-call, up to 24 hours a day.” Health Minister Lawrence Springborg said Queensland had one of the largest managed telehealth networks in Australia with more than 1500 systems deployed in over 200 hospitals and community facilities. He said they had been installed in previous years but were largely underutilised, and that he wanted to reinstate a number of services that had been lost through these idle systems, particularly in paediatrics, oncology and cardiology.
cdmNet can help improve clinical outcomes in diabetes care The clinical outcomes of patients with diabetes can be significantly improved by using general practice management plans and team care arrangements underpinned by web-based shared care management systems, an Australian study has shown. The study, published in the Medical Journal of Australia, looked at the management of 577 people with types 1 and 2 diabetes over 14 months, before and after the introduction of Precedence Health Care’s cdmNet system to help manage their care. cdmNet is a web-based technology that enables team-based care, allowing GPs to create care plans best suited to the patient’s needs. Specialists, allied health professionals, pharmacists and the patient themselves can access the health record and care plan. It is being used in the federal government’s Diabetes Care Project (DCP), which is assessing the use of technology, care facilitators and flexible funding models to improve care for people with diabetes. The DCP is the largest ever diabetes trial in Australia, with over 6500 active patients, 650 participating GPs and practice nurses and over 800 allied health professionals.
In the Monash Universityled study, which was co-authored by Precedence Health Care’s founder and CEO, Michael Georgeff, and its clinical integration lead Marienne Hibbert, significant improvements were seen in the quality of care and clinical outcomes for patients whose care was supported by cdmNet.
“Without the use of advanced internet and mobile technologies, one simply cannot achieve the level of coordination and follow up needed for these patients.” The main improvements came from a boost in regular reviews of GPMPs and TCAs, with 80 per cent of patients on a care plan created and managed using cdmNet regularly reviewed and followed up compared with national figures that indicate that less than 20 per cent of patients’s plans are regularly followed up. It also showed that for those patients who received regular reviews, 85 per cent adhered to best practice care, compared to 59 per cent otherwise.
The authors say that one explanation for this improvement is that placing patients on a GPMP or TCA helps the GP implement best practice guidelines and encourages the patient to adhere to these. cdmNet also reminds patients to make and attend appointments. Clinical outcomes were also improved, with a statistically significant improvement in overall levels of measurements such as blood glucose and cholesterol levels. The greatest improvements were in patients who had regular reviews of their care plan. Measurements of quality of care and clinical outcomes were based on the diabetes annual cycle of care (ACOC). Professor Georgeff said the study suggests that improvement in clinical outcomes is related to the level of coordination among the care team and with the patient. It also indicates that patients are more likely to adhere to their plan when it is regularly reviewed and followed up by the GP and the care team. “Without the use of advanced internet and mobile technologies, one simply cannot achieve the level of coordination and follow up needed for these patients,” he said.
John Murtagh’s General Practice goes digital with 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 of medicine. 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 said. “They went with the apps and it’s a
brilliant idea. “The new app gives students and health professionals the most upto-date information, based on our research.” It is believed these are the first medical flashcards to be developed in Australia. John Murtagh’s General Practice was first published in 1994 and has become the seminal reference for medical students and professionals. The text has been adopted widely both in Australia and Asia and is the highest selling medical textbook of the past 20 years.
Webstercare launches antipsychotic drug report Pharmacy software specialist Webstercare has worked with medicines information service NPS MedicineWise to develop a new reporting function that will allow aged care facilities to monitor and review their use of antipsychotic medications for residents with dementia. The new quality use of medicines (QUM) report functionality is now available to all Webstercare users through its Medication Management Software (MMS). The reporting mechanism will help pharmacists to provide information to staff working in aged care facilities and aid them in effectively managing the appropriate use of antipsychotic medicines for residents. Webstercare CEO Gerard Stevens said it didn’t matter which of the Webstercare products the pharmacist was using, including Webster-pak or Unit Dose 7, as the same data was recorded in the database. He said the quality and accuracy of the data was incredibly high as every detail of the prescribed drugs, including day and time they must be administered and in what combination, is double-checked by both the pharmacist and the nursing staff. The new function will allow aged care facilities to compare their antipsychotic drug administration with other facilities and to benchmark themselves against two evidence-based studies. Mr Stevens said the idea was not to produce a guide to overuse or underuse as some facilities will have higher or lower use for a number of reasons. “What this will do is help you investigate whether your level is appropriate,” he said. “If there is overuse, you can then intervene and come up with a strategy.”
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HCF expands health monitoring in the home Health insurer HCF is rolling out what it calls the largest ever telemonitoring program in Australia, partnering with health management company Healthways and Telstra to provide wireless monitoring devices for use in the home. The rollout follows a trial last year of a mobile glucometer for people with diabetes in association with the My Health Guardian program, which provides a web portal, mobile apps and nurse-led support for people with chronic illnesses. HCF, which in addition to insurance runs the Manchester Unity retirement and aged care business subsidiary, began trialling the use of Bluetooth-enabled devices for chronic disease patients last year. Data from the glucometers was automatically sent by smartphone to Healthways for routine monitoring. In an expansion of this trial announced recently, HCF will provide a number of different WiFi-enabled devices such as weight scales, blood pressure monitors, glucometers and oximeters. The medical devices interact wirelessly with a Telstra machine-to-machine device, and the data is then transmitted through the Telstra Next G mobile network to Healthways. Nurses can monitor the results and intervene if changes occur. HCF also offers a My Health Guardian mobile app for iPhone and Android that links to the portal and provides motivation, daily actions and reward functions. Benefits include improvements in perception of health scores and medication management and reductions in smoking, physical inactivity and poor diet. The extended telemonitoring service will in time provide bio-metric monitoring combined with telephone-based health support to approximately 3300 members.
iPhone app with ECG a candidate for mass atrial fibrillation screening The University of Sydney is 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 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 funded by the National Heart Foundation. 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 device is available in the US following approval as a medical device by the US Food and Drug Administration, and is also available in the UK and Ireland. Ms Lowres said the device has been approved by Australia’s Therapeutic Goods Administration and she understands it will be available here in the very near future.
Senior author Ben Freedman, a professor of cardiology and deputy dean of medicine at the University of Sydney’s Concord Clinical School, said the device was a highly effective, accurate and cost-effective way to screen patients to identify previously undiagnosed AF and help prevent strokes. Professor Freedman said that the iECG would allow clinicians to screen patients for AF in minutes, and treat people early. “This is a huge boost in the fight to reduce the amount of strokes, particularly in people over the age of 65,” he said. The device snaps onto the back of an iPhone to record, display, store and transfer single-lead ECG rhythms wirelessly with the AliveECG app. Recorded rhythm strips are stored in the app and sent to a secure server
that can automatically analyse the reading. It can also be sent securely to the cloud in PDF format for review by a cardiologist. The University of Sydney research team, as part of its Screening Education And Recognition in Community pHarmacies of Atrial Fibrillation (SEARCH-AF) stroke prevention study,
found that the website’s automatic prediction was able to correctly diagnose AF 97 per cent of the time. In the SEARCH-AF trial, 10 pharmacies were recruited and screening offered to all customers over the age of 65. Each screen took less than five minutes to complete and consisted of a brief medical history,
pulse check and a singlelead iECG. Of the 1004 participants screened, one per cent were found to have previously unknown AF and an additional half a per cent were re-identified with AF. The research also showed that only 66 per cent of those eligible for stroke prevention medication were being prescribed it.
Telstra buys DCA’s healthcare division Telstra has acquired the healthcare division of Database Consultants Australia (DCA), which markets the Argus secure messaging service and the tcm and Communicare clinical software packages. DCA Health has a diverse portfolio and has made a few purchases of its own, including last year’s acquisition of Aboriginal healthcare software specialist Communicare and the recent purchase of CSC’s residential aged and community care assets. DCA Health general manager Peter Young said the company would continue as normal and it would not be consumed into Telstra’s internal structure. “DCA has taken its health assets and around 80 staff and we have created our own company, DCA Health,” Mr Young said. “Shares in that company have been
sold to Telstra as a fully operational entity. We will continue [as usual], all the staff and the customers, will continue.” Telstra’s head of healthcare Shane Solomon said the acquisition was part of building capability in Telstra’s growing health portfolio. Earlier this year, Telstra made a substantial investment in online health directory and appointment booking service HealthEngine and in IP Health, which markets the Verdi electronic health record software used at the Peter MacCallum Cancer Centre and the Mater Hospital in Queensland. One of DCA Health’s assets is its Human Services Directory (HSD), which it built and manages for the Victorian government. The HSD has since been used as the basis to build the
National Health Services Directory (NHSD), which DCA Health is contracted to develop and maintain on behalf of Healthdirect Australia. The NHSD contains an endpoint locator service (ELS) to enable secure messaging of encrypted health data. Mr Young said DCA Health has the right to commercialise the HSD overseas, which it plans to do. DCA Health also bought the Argus secure messaging service in 2010 and also owns an SMDcompliant messaging service gateway called ConnectingCare, which is interoperable with Argus and the HSD. Telstra Health’s Mr Solomon said the future of healthcare will see more patients cared for at home and that technology will play a critical role.
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Colleges develop online learning module for eHealth The Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM) have developed a new online education module that provides information and resources on the integration of a range of eHealth technologies in general practice. The colleges said the “Making eHealth work for your general practice” module aims to assist GPs in adopting appropriate eHealth systems, build eHealth awareness, help GPs understand the principles and benefits of the PCEHR and simplify the implementation of eHealth. ACRRM president Richard Murray said the colleges “recognised the lack of objective information” about the PCEHR in general practice, including the technology, functionality, privacy, security and, most importantly, usefulness. “With the support of the Commonwealth government, the colleges have now developed this first-of-a-kind learning activity,” Professor Murray said. “We hope it is a catalyst for more rural doctors to be actively involved in discussions regarding shared records and contribute to the evolution of the system.” RACGP president Liz Marles said that as the capability of the PCEHR develops over time, genuine engagement from GPs is urgently required to shape the evolution of the system to ensure it is a success. She said the learning module can help provide knowledge and skills in the optimal applications of eHealth technologies and processes such as the PCEHR, telehealth, clinical software, secure messaging and social media. It is available free of cost to members and is hosted on the RACGP’s gplearning portal or ACRRM’s RRMEO platform.
SA hospitals begin sending electronic discharge summaries to the PCEHR Nine hospitals in South Australia are now sending discharge summaries to the PCEHRs of registered patients. SA Health sent out a directive in July mandating a uniform approach to sending discharge summaries to the PCEHR for eight metropolitan and one regional hospital.
“Together, they provide a bridge between current SA Health hospital systems and the national eHealth record system. This solution is now operational across all metropolitan hospitals (excluding Noarlunga General Hospital in the short term) and Mt Gambier Hospital.”
Each hospital’s medical records department is charged with reconciling Individual Healthcare Identifiers (IHI) on a daily basis to ensure accurate data integrity and to match the details of a patient in hospital with their PCEHR.
“The irony is the clinicians have signed off, EPAS is signed up and we get caught by the accountants.”
It is not known how many summaries have been sent, but one Adelaide GP who is actively using the PCEHR with patients has reported that a discharge summary from Lyell McEwin Hospital has appeared on a patient’s record.
The spokesperson said SA now had the largest number of hospitals capable of sending summaries to a patient’s PCEHR and is the first multi-hospital state in Australia to achieve this.
An SA Health spokesperson said the organisation had developed a new IT solution which allows hospitals to send electronic discharge summary information to a patient’s PCEHR if they have registered for one.
“This new database is being considered by a number of other state health departments, including Western Australia, Queensland, Tasmania and the Northern Territory, as a way to meet their own requirements to send information to the PCEHR.”
“The solution includes the creation of a new database and a change to an existing hospital administration system,” the spokesperson said.
St Vincent’s Hospital in Sydney has had the ability to send discharge summaries to the PCEHR since late last year, and
NSW Health recently revealed it planned to begin a wider rollout of electronic discharge summaries from hospitals to GPs, with the ability to upload them to the PCEHR. The SA hospitals that now have the capability are Royal Adelaide, Queen Elizabeth, Flinders Medical Centre, Modbury, Glenside, Women’s & Children’s, Repatriation General, Lyell McEwin and Mt Gambier. The SA Health spokesperson said the interim solution will not be implemented at Noarlunga General Hospital, as it is the first trial site for the rollout of SA’s new Enterprise Patient Administration System (EPAS), which has been designed by Allscripts. The spokesperson said SA Health is currently developing a strategy to allow EPAS to send discharge summaries to the PCEHR. As part of the contract with Allscripts, SA Health has purchased a licence to provide patients with read-only access to some information in their medical record held in the new EPAS solution through a webbased portal. Pulse+IT understands that the other hospitals are using their existing patient administration systems,
including OACIS, with a health information broker (HIB) add-on. OACIS and other legacy systems will be decommissioned following the wider roll out of EPAS, which is expected to be complete in 2014 or 2015. The roll out was initially planned to begin in earlier this year, but was delayed by problems with its billing modules. SA Health CIO David Johnston told the Sydney Morning Herald in March that Allscripts had advised in late 2012 that the delivery of the billing modules would be delayed by about two months. “That two-month delay really translates into a three or four-month delay,” Johnston told the newspaper.
“But we can’t put an exact date on going live until we’ve done the last of the billing module tests. If billing is not right we can’t go live. “The irony is the clinicians have signed off, EPAS is signed up and we get caught by the accountants. “That’s usually not the case, it’s usually the clinical components that cause delays due to their high complexity.” Opposition health spokesman Rob Lucas is claiming that there would be a further delay of 11 months until the whole system was rolled out. Mr Lucas said the roll-out to the Repatriation Hospital, Port Augusta Hospital and Lyell McEwin Hospital prior to March 2014 “is unlikely to occur”.
South Australian health minister Jack Snelling told the Adelaide Advertiser that he was confident EPAS would be ready when construction of the new Royal Adelaide Hospital was completed in 2016. The new hospital has been designed to be paperless, and will have no storage space for old records. Mr Snelling said Noarlunga Hospital would be the first to receive the program – which began implementation in August – and it would later be extended to larger locations including the old Royal Adelaide for more testing. NEHTA has not responded to several requests from Pulse+IT for more information on how the different states are planning to upload discharge summaries to the PCEHR.
Grampians ML launches dementia pathways tool Victoria’s Grampians Medicare Local has officially launched a dementia pathways tool for GPs and nurses involving a webbased repository of a range of localised information and resources to help enhance assessments and referrals for people with dementia. Health pathways in the primary care sector are an increasingly popular tool to help clinicians – particularly GPs but also practice and community nurses, hospital specialists and allied health providers – to link patients to local services and specialists. They can also contain evidence-based symptom outlines and management options. The Grampians pathway for dementia is not restricted to GPs only and has been developed by the Victorian Department of Health in collaboration with the University of Ballarat’s Centre for eCommerce and Communications (CECC), which developed the software component of the pathway. The interactive pathway is designed to assist GPs with early intervention, diagnosis and ongoing management of patients with dementia. It promotes positive awareness of the first signs and symptoms of dementia, assessment and investigation of suspected dementia and the importance of linking people with dementia and their carers to appropriate community services. It also provides evidence-based advice and guidance on areas such as pharmacological interventions and palliative care and end-of-life care planning. It also has links to downloads of common assessment tools such as the Abbey Pain Scale, Confusion Assessment Method (CAM) diagnostic algorithm, and the General Practitioner Assessment of Cognition (GPCOG) tool.
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HSAGlobal adds advance care planning functionality New Zealand-based collaborative care software vendor HSAGlobal has introduced new advance care planning functionality into its Collaborative Care Management Solution (CCMS). CCMS is widely used in NZ, including in Auckland’s National Shared Care Project and in Canterbury for its Collaborative Care Program. South Eastern Sydney Medicare Local has signed up to use CCMS to manage its Access to Allied Psychological Services (ATAPS) and Partners in Recovery programs, and CCMS is being considered by a number of others for a range of collaborative programs. SESML’s ATAPS went live on July 1. HSAGlobal plans to include advance care plans (ACP) in CCMS for use in New Zealand over the next couple of months and in Australia by the end of the year. CCMS is also capable of creating a number of care plans, including shared care plans, acute care plans and long-term care plans, with a medications management plan for use by community pharmacists and patients to come online soon. HSAGlobal’s business development manager, Stuart Barson, said CCMS will eventually underpin a national, web-based system being rolled out for long-term condition management. Clinicians using the technology will now also be able to create and share ACPs and link them to the patient’s shared care plan. Mr Barson said that because CCMS is a flexible platform that has the ability to run multiple plans for multiple programs, adding ACPs was the next logical step. It will also allow GPs to collaboratively work with the patient, their families and hospital clinicians on creating the plan.
Anywhere Healthcare adds to specialist panel for national telehealth rollout Medibank Health Solutions plans to have a panel of up to 30 specialists offering video consultations by this month as part of the national rollout of its new Anywhere Healthcare telehealth service.
and dermatology. All appointment bookings and session management are handled by Anywhere Healthcare.
Anywhere Healthcare was officially launched nationally in May following a scoping period in the Queensland town of Gladstone and in Darwin last year.
Sam Holt, Medibank Health Solutions’ director of online care, said the panel will also include geriatricians, neurologists, endocrinologists, ophthalmologists, oncologists, cardiologists and obstetrician/ gynaecologists.
The service is free to GPs and offers a panel of specialists who work as part of a virtual private practice, with current disciplines including paediatrics, psychiatry, general medicine
Medibank Health Solutions has had a large telephonebased triage business in Australia for a number of years, and has contracts with both governments and the corporate sector. It is contracted to provide the
after hours GP helpline and healthdirect Australia on behalf of the Australian government. Mr Holt said moving into video consultations for GPs in rural and remote areas was the next logical step. “We saw that there were a myriad of opportunities, and we decided to concentrate initially on what we call our virtual healthcare clinic, which is the service where we offer our panel of specialists,” Mr Holt said. “We did a lot of market research in the early days to determine what it was that GPs were looking for when it came to telehealth. What we learned was that GPs were quite technology-
agnostic. What the doctors told us they wanted was a service that was efficient for them to use.” Mr Holt said GPs were looking for specialists who could dedicate specific time to telehealth rather than just run it as part of their traditional face-to-face practice, as there was a high likelihood that they wouldn’t run on time. “Even though GPs are remunerated under the telehealth incentives scheme, they don’t believe that the incentive is enough to warrant them sitting around for unnecessary amounts of time with patients or tying up rooms waiting for specialists. The service was first rolled out in Gladstone, which has a dearth of local specialists but a growing population, Mr Holt said. “They have a lot of healthcare access problems and we saw that as a good target as a community that would benefit from the service. “It wasn’t a pilot per se but an opportunity for us to gauge what would the likely volume of consultation or referral requests be so that when we launched the product nationally, we could ensure that we had the right balance for client demand. The service is free to GPs working in telehealth
eligible service areas, who are able to claim the MBS telehealth rebate. Anywhere Healthcare employs the specialists on a sessional basis and handles all of the billings. It uses the Vidyo video conferencing solution, but Mr Holt said there were no set-up costs for GPs.
“The only thing a GP needs to do in order to access our service is to download the Vidyo platform.” To date, all of the consultations that have taken place have been bulk-billed, meaning there is also no out of pocket expenses for patients. “The only thing a GP needs to do in order to access our service is to download the Vidyo platform,” he said. ”It is free for them to download and there is an app if they want to use an iPad. If the GP rings us at nine o’clock in the morning, we can set them up and get them ready to do consultations within an hour.” Anywhere Healthcare runs a full practice management support team and offers a telehealth concierge service with every call. “The first person you would see if you were a GP or practice nurse
is our support staff, and we will do a quick technical audit to make sure that everything is working. “We aim to provide referral turnarounds in under two weeks, so for patients who wait many months for a specialist appointment, we can get them in to see a specialist in under two weeks and in many cases in a matter of days.” The Department of Health will this year investigate whether to open up direct GP or specialist to patient video consultations on the MBS, which many telehealth providers are watching with anticipation. Mr Holt said while there were no plans as yet, direct to consumer services are definitely on the horizon. The main hurdle for many people living in rural and remote regions is the quality of internet provision. “We have done testing with close to a thousand different sites around Australia, and what we have learned is that there is still today a requirement to add an element of technical assistance in telehealth. “Once things like the NBN have been rolled out ... I think you will be in a better position to start being able to offer fully automated services that allow patients to go online and find a GP and have a consultation without any other human interaction.”
AutumnCare takes Medicate solution on the road Aged care software vendor AutumnCare has kicked off a national roadshow of its Medicate medication management module, first launched at the Information Technology in Aged Care (ITAC) conference in Melbourne last year, with an update released in April. AutumnCare’s managing director Stuart Hope said Medicate was designed from an aged care clinical rather than a pharmacy perspective, with a closed loop approach taken to clinical practice. This approach helps ensure proper documentation and follow up of the administration of medications, Mr Hope said. “For instance, if a PRN is given ... we automatically create a note properly categorised, flag it for hand-over, and can notify clinicians if an organisation’s processes require it. We also graph the time of administration. The nurses have to sign off on all medications they administer, or give a reason why they haven’t.” Medicate is integrated into the company’s primary aged care solutions, Enterprise and Harmony, which are offered to aged care providers depending on size and type of service. It is also fully integrated with a number of pharmacy systems, including FredPak and Webstercare. The showcase will involve a full demonstration of the system by AutumnCare’s Eileen Ross, a registered nurse, as well as Irene Mooney of aged care provider Quambie Park Waroona, one of the first facilities in Western Australia to implement Medicate. AutumnCare recently released version 4.4 of its enterprise-grade product, featuring a way to take a photo using any Windowsbased device that allows it to be added to the patient’s record, including photos of wounds that can be directly embedded into the wound management assessment form.
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Mobile watch designers expand into aged care Personal care technology company mCareWatch has made its anticipated move into residential aged care, launching a monitoring and support system called ConnectiveCARE for aged care facilities. mCareWatch’s SOS Mobile Watch was officially launched in June and is aimed at elderly people living in their own homes, their carers and families. The device actually is a watch, but it also functions as a mobile phone, a GPS tracking device and a medical alert system. ConnectiveCARE is a software platform that enables 24-hour connection between residents, community care clients and facility carers. That includes monitoring of residents’ whereabouts – both within the centre and outside of it – along with twoway voice connection for client and carer. Building on the features of the SOS Mobile Watch, ConnectiveCARE is aimed at larger scale care organisations and their residents, and a number of facilities are set to install it, the company’s co-founder, Peter Apostolopoulos, said. As well as its GPS and SOS functionality, the ConnectiveCARE system can send alerts when particular clients leave designated areas via a Geo-Fence functionality. It can also be programmed to differentiate between client ‘groups’ to accommodate different levels of care need and deliver an additional layer of safety and security when clients are outside the facility, on individual or group outings, for example. Mr Apostolopoulos said all a client needs to do is wear the watch, which is linked to the ConnectiveCARE platform, key caregivers and relatives via the mobile phone network.
Canberra and Queensland hospitals go paperless in intensive care Calvary Hospital in the ACT went live with the MetaVision electronic clinical information system from iMDsoft in its intensive care and coronary care units in late July, joining Canberra Hospital, two private hospitals in NSW and six public hospitals in Queensland in installing the system. Canberra Hospital has been using MetaVision for over two and a half years, along with the Sydney Adventist Hospital and Macquarie University Hospital. Three large hospitals in Brisbane are currently rolling it out. The Royal Brisbane and Women’s, Princess Alexandra and Royal Children’s hospitals will join Gold Coast, Prince Charles, Townsville, Rockhampton, Cairns and Logan hospitals in using the system as part of a statewide enterprise roll out that will hopefully take in the rest of the smaller regional hospitals as well. Brent Richards, director of intensive care at the Gold Coast Hospital and chairman of Queensland’s Statewide Intensive Care Clinical Network, said he hoped the system would be rolled out to as many as possible. “Politics and dollars are always a challenge but when we do the next three,
it will be about two-thirds of the major hospitals done,” Dr Richards said. “There are still some mid-sized ones that we’d like to do but that will be very dependent upon executive buy-in in those sites.” Dr Richards has been a champion for the new system, which he said is delivering improvements in workflow.
“Politics and dollars are always a challenge but when we do the next three, it will be about two-thirds of the major hospitals done.” “The first thing is that with automated systems, it is all legible and identifiable,” he said. “You don’t quite realise how important that is until you’ve got it. The more you’ve got it the more you realise that it is so much easier and safer. “ICU is incredibly complex and can be quite hard to computerise, because we have a lot of data flow. You want to capture all of that data including the data from the equipment interfaces, which is transferred minutely in MetaVision.
“Giving drugs is a lot more complex because ICU patients frequently have numerous infusions, and there is frequent real-time management of infusions – titrating medication infusions is normal in ICU – and the system has got to be able to capture it.” 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. Dr Richards said simple legibility in clinical notes was one of the main benefits, along with safety improvements. “One of the best things about iMDSoft is it has a very strong allergies to medications functionality,” he said. “Not many systems do that. If I put in that they are allergic to penicillin and I try to put in any [in that family of antibiotics] it comes up with an alert. You have to double sign it before you can go ahead.”
Toni Laracuente, business development manager for iMDsoft, said the system was specifically designed for the complex environments found in critical care. “It covers intensive care for adults, paediatrics and neo-nates, and it is also an anaesthetic system as well, so it works in the OR,” she said. “We also have many specialist departments using it for critical care such as burns, neuro, trauma and cardiology, all areas of high acuity. “MetaVision allows them to create a fully automated environment and there is no paperwork. It does a full electronic medical record, medications management and decision support, and also all of the very complex IV infusions. There are not many critical care systems
on the market because it is an extremely complex area to work in.” Dr Richards said the Gold Coast ICU is a completely paperless system, with the only paper coming from outside of the department. “All of the observation charts are on the system, all of the notes are in the system, all of our prescribing is in the system, and all of our monitoring of fluids is in the system.” He said the first six installations were relatively easier than what is confronting PAH, Royal Brisbane and the Royal Children’s, as all of those were previously using paper. While the MetaVision system does have the ability to interface with third-party EMRs, in Queensland it
is currently being used as a standalone product. It can draw information from the Hibiscus patient administration system and the AusLab laboratory system, but Dr Richards said he wanted to keep the ICU database as the source of truth for ICU data. There are no plans as yet to interface the system with the Cerner EMR that is being rolled out in some hospitals in Queensland, as the Cerner system is only a basic version and is not on an enterprise level, Dr Richards said. iMDsoft has introduced some new add-ons this year, such as MVpanorama, which provides crosspatient management, and MVdashboard, a browserbased application for accessing unit and patient data at a glance.
Medicare Local signs with Intrahealth to offer hosted IT Townsville-Mackay Medicare Local (TMML) has formed a partnership with software vendor Intrahealth to offer a suite of fully hosted and customised software solutions to other Medicare Locals and community and allied health organisations. Intrahealth’s Profile practice management package has been used by TMML in its previous incarnation as a division of general practice since 2008. It has since customised the functionality to develop a number of software modules specifically for its own requirements, including managing programs such as ATAPS, headspace and Partners In Recovery. Now, TMML is offering these software modules as an Enterprise Health Management Suite (EHMS) to other organisations as a hosted solution, particularly targeting other Medicare Locals who don’t have the necessary IT expertise and to community and allied health organisations to help better manage their businesses. TMML’s clinical business systems manager Colleen Watkins said the EHMS can provide a “whole of business solution” which tracks patient records and forms, financials, administration requirements and other functions. Intrahealth’s general manager Craig Longstaff said TMML has some “incredibly knowledgeable” resources and has configured and developed aspects of the Profile tool to meet their clients’ requirements. “It seems a logical step to enhance this relationship from a purely customer relationship to a partnership agreement, whereby TMML can offer Intrahealth products and related services to other organisations in Queensland,” he said.
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GPs to recruit allied health to PCEHR for diabetes care General practices in western Sydney are being encouraged to each recruit two allied health professionals who are involved in the care of patients with diabetes to register to use the PCEHR. NEHTA’s measurement and validation manager Heather McDonald told an Australian Information Industry Association (AIIA) forum in Sydney recently that as part of a ‘meaningful use’ project centred in western Sydney, 150 people with diabetes were being targeted in an attempt to get health professionals other than GPs involved in the system. “That is who the [Department of Health and Ageing] and ourselves have been targeting: GPs with their ePIP payments,” Ms McDonald said. “Now we are encouraging each GP practice to register two allied health professionals that will support the diabetic patients – podiatrists, pharmacists, physiotherapists, dieticians.” She said approximately 5000 shared health summaries had been created and uploaded to the PCEHR. Public hospitals are now beginning to upload discharge summaries, including from nine in South Australia, and the aged care sector uploaded its first event summary recently. “We are starting to look at what the uptake is but also what the downloading is – how many people are starting to view the records, because until people are starting to view them, we can’t even think about meaningful use,” she said.
Townsville telemedicine service achieves net savings in travel costs A study of the Townsville Cancer Centre’s teleoncology service over almost five years has found that it can achieve net savings through major reductions in travel costs for patients and specialists, which could then be redirected into enhancing rural health resources. The study, published in the Medical Journal of Australia (MJA), was aimed at assessing whether there was a cost benefit to using a telemedicine model of cancer care compared with the usual model of care. It assessed 605 teleoncology consultations with 147 patients over 56 months, which the authors estimate had a total cost of $442,276. However, they also estimated that the travel expenses avoided by using video consultations totalled $762,394, a figure that included the costs of travel for patients, escorts and specialists, aeromedical retrievals and some accommodation costs.
The challenge for the PCEHR was now overcoming usability and workflow issues.
“This resulted in a net saving of $320,118,” the researchers found.
“For GPs it has to connect to their admin systems as well as clinical systems, for hospitals there are a dozen clinical systems and for aged care they have their admin systems, so you can’t design stuff in isolation,” she said.
The researchers write that the Townsville Cancer Centre (TCC) set up a teleoncology service for its rural satellite sites in 2007, including Mt Isa, which is
900km from Townsville. In this study, the vast majority of patients were from Mt Isa but several used the service from Proserpine, Hughenden, Winton, Doomadgee and three sites in the Gulf of Carpentaria. “The Townsville teleoncology model involves videoconference sessions in which medical oncologists consult with patients who may be supported during the videoconferences by local health care professionals,” the researchers write.
“These rebates would provide further financial benefit to the hospital and health services from the telehealth model.” “Referrals to the teleoncology service are managed by a coordinator at TCC. The need for local health care professionals to be present during videoconferences is determined by the complexity of the cases. This means that, in some cases, patients attend videoconferences alone.” Costs included one-off equipment purchases,
continuing maintenance costs and the salaries of a part-time service coordinator and a chemo nurse in Mt Isa. The savings were attributed to avoiding travel by patients and escorts to a tertiary centre; avoiding overnight accommodation for patients and escorts in Townsville; avoiding aeromedical retrievals; and avoiding travel by specialist oncologists. “Seeing patients urgently by means of videoconferencing and advising the necessary management plan to local medical services avoided aeromedical retrieval of patients from satellite sites to the tertiary centre, thus representing further savings,” the researchers write. “Finally, regular threeweekly visits to satellite sites by a specialist oncologist became unnecessary. We based savings calculations for specialist travel and accommodation on the same prices used to calculate costs for patient travel and accommodation.” The researchers write that while other studies have shown there are no or negligible savings by using telehealth compared to face-to-face consultations, this study and several others that concentrated
on services covering vast distances did show cost savings. “In our model, in Mt Isa, all the medical oncology services were able to be provided locally by telehealth, which avoided interhospital transfers and
led to further cost savings. However, our findings may not be generalisable to models with smaller patient numbers and with patients travelling smaller distances. “Since July 2011, more than 80 per cent of our
consultations have been eligible for a Medicare rebate by the Australian government. While we did not include this in our cost analysis, these rebates would provide further financial benefit to the hospital and health services from the telehealth model.”
EpiSoft to launch Cancer CareZone Sydney-based software developer EpiSoft has received a grant from Commercialisation Australia to help launch a new cloud-based solution for integrated cancer management later this year. Called Cancer CareZone, the new system is aimed at medical oncology and haematology but will also allow for the provision of shared care with cancer surgeons, skin cancer procedural specialists, pharmacists, GPs and radiation oncologists and hospital staff. The software is underpinned by EpiSoft’s protocol management engine EpiSteme, which the company says is currently being tested in the field for hepatitis shared care. The idea is to allow expert cancer practitioners to publish, distribute and contribute to a comprehensive online cancer treatment pathway and health record.
EpiSoft has for some years worked with a number of leading researchers and practitioners in a range of disease areas, most particularly gastroenterology where a cloud-based clinical system for clinical care and research into Crohn’s disease and colitis is now in use across the ANZ region. The software allows each practitioner to keep their own patient records separate, but to share de-identified patient data for research purposes. This system has now been extended to hepatitis specialists, and will form the basis of a new gastrointestinal CareZone. The Cancer Institute’s EviQ protocols will form the starting point for the EpiSteme system in cancer, which will expand chemotherapy drug regimens into a more complete treatment “prescription” covering appointment scheduling, prompts to order tests,
review results and perform other important tasks. It will also feature automated alerts to the care team based on data in the system such as out of range results, and requests for patients to register and complete online quality of life measures or participate in other online aspects of their care. EpiSoft director and cofounder Jenny O’Neill said the company will launch the new system in October in a specialist oncology practice that operates its own chemotherapy centre. “The oncologists can share the record with surgeons and radiation oncologists and GPs, but also with hospital staff if they are admitting into a hospital,” Ms O’Neill said. For GPs, the plan is to provide either electronic letters or, for shared care, a “single page” within the system that they are given a log-in to access.
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Black Dog launches online suicide prevention trial The Black Dog Institute is running a trial of an online intervention for people experiencing suicidal thoughts that can be accessed at all hours. The trial involves a six-week program to study the effectiveness of the intervention compared to a different program. Online self-help programs have been shown to be effective in helping manage anxiety and depression, but this is one of the first in the world to look at whether they are also effective in helping manage suicidal ideation. The Healthy Thinking trial is currently recruiting adults between the ages of 18 and 64 who are experiencing suicidal thoughts. The trial began in September. Black Dog Institute executive director Helen Christensen said the Healthy Thinking program has been designed to circumvent the issues of stigma that often stop people from seeking face-to-face help. “We know that many people are reluctant to acknowledge their thoughts of suicide,” Professor Christensen said. “The ‘Healthy Thinking’ trial is offering people a confidential self-help service that can be accessed 24/7 by anyone with internet access.” The trial is backed by a new report sponsored by Lifeline Australia. Lifeline chairman John Brogden said the results showed a growing preference among consumers to use the internet when seeking help during times of crisis. “Internet technology is a smart solution for suicide prevention,” Mr Brogden said. Professor Christensen recently won a major NHMRC fellowship worth $3.75 million to develop eHealth technologies to bridge translation gaps in mental health.
iCIMS brings native interoperability to clinical specialties Well-known health information specialist Jon Patrick has developed what he calls a new class of technology to address the need for custom-designed information systems for clinical specialties. Since leaving the paid service of the University of Sydney in July last year, Professor Patrick has established two new companies, one called Health Language Laboratories (HLL) and the other Innovative Clinical Information Management Systems (iCIMS). Professor Patrick said HLL was developed to use his experiences to create industrial language processing products, which have been used in a recent project for the Victorian Cancer Registry involving information extraction and
information inferencing for radiology reports. “Radiology reports are particularly interesting because no one around the world seems to be using them for cancer registries,” he said. “It’s innovative and it’s a wealth of knowledge about cancer which is not being exploited in terms of the population distribution of cancer.
technology for clinical systems produced at a much lower cost than hospital solutions from the large vendors. He believes that clinical solutions have to be readily changeable, and “it has to be clinical team-designed and it can’t be designed by the vendors,” he said.
“It brings a much better focus on recording a range of cancers that you never get pathology reports for, such as brain cancers and benign cancers. You also get the opportunity to get a staged diagnosis … so you are getting cancer information much earlier in the cancer journey.”
The technology consists of a design tool that can be used by the clinical team to create a system that suits their needs and can interoperate with enterprise-level clinical information systems such as EMRs and pathology and radiology systems through HL7 messaging. The technology also enables the clinical systems to be changed in real time.
With iCIMS, Professor Patrick is attempting to create a new class of
Clinical teams can use the design tool to create a system, with the support of
iCIMS process analysts, that does not require any further programming between the design stage and creating the run-time system. “There’s no programming, no data table design, no SQL design, nothing,” he said. “It represents a very significant change that we call an emergent clinical information system.” The new technology uses what Professor Patrick has coined “native interoperability” to call up data from other clinical systems, and it can be used to develop systems for many different clinical specialties, as well as patient flow purposes such as theatre and ward management and to design clinical and scientific registries. Professor Patrick describes an emergent CIS as the notion that what a clinical team wants emerges from the design process and it may have behaviours that are not part of a prespecified design.
and then commission, and that’s it.” One of the benefits is that clinicians can make changes to the system in real-time without having to ask an IT vendor to do it for them. If it is a major change then iCIMS’ process analysts will help, but if it is merely a new field that needs to be added or deleted, the clinical team will have the ability to alter their system themselves.
“The notion of native interoperability is that when you build your own clinical system in our environment, you can refer to any field in any other system.”
“They may have emerged from the way they put things together and the whole is greater than the sum of the parts,” he said.
“As part of the contract they have a copy of the design tool. That gives them a great deal of confidence even if they never use it. They have the confidence that they have control over their own system, and they can ring us if they want us to do it or they can do it themselves.”
“The other important part is that it completely moves you out of the waterfall model of system design – you are no longer in that process at all. What you have is a continuous iteration of design and test
This is important for clinical specialties, which often have their own idiosyncratic workflows and different needs from site to site. This often makes it almost impossible even for the best-of-breed vendors to
design a suitable system for clinical specialties aside from ED and ICU, he said. The iCIMS system is suitable for a large range of clinical specialties, such as emergency department, gynaecological oncology, breast cancer and trauma, as well as the creation of tumour registries and theatre, surgical ward and general ward management. “Our operations model consists of all of these clinical specialty systems that are highly changeable, highly adaptable, which is what we deliver,” he said. The iCIMS system uses a graphical user interface (GUI) rather than a script, and the programming language allows users to call up information by reference. The technology has been used in a proof of concept trial for the Victorian Comprehensive Cancer Centre, with a gynae oncology system designed for Melbourne’s Royal Women’s Hospital and a breast cancer system for the Royal Melbourne Hospital. iCIMS has also built an ovarian cancer and a cervical cancer system for clinicians at the Peter MacCallum Cancer Centre that are fed data automatically using native interoperability from the gynae oncology system installed at the Women’s.
eMIMS now available on the desktop and in the cloud MIMS has developed two delivery platforms for the new version of its eMIMS drug reference product, launching a cloudbased version in September with a desktop version to follow. The new eMIMSCloud allows users to access the resource by key, click or touch on a PC or Mac desktop or laptop or Android tablet. It is supported in Internet Explorer, Firefox, Safari and Chrome. It contains current Australian product and consumer medicine information, up-todate PBS restrictions and pricing and a drug interactions database. It also has additional links to TGA safety bulletins, NPS RADAR and NPS medicines update articles, and will be updated automatically on the first of each month. The new Product Identification module includes the ability to search by shape, form, colour, scoring, marking or symbols or search by therapeutic class, company, brand name or generic. The product size has also been added to the descriptions, which MIMS said was something that has long been requested by customers. Users who prefer to install eMIMS locally will be able to do so through eMIMSDesktop, which will be released later this year. It is only available to Windows users and the installation files can be supplied either on DVD or downloadable from the MIMS website. MIMS country manager Siobhan Murphy said a modern interface and simple functionality is shared across both delivery platforms as is the resource-rich content. What differs is simply the way MIMS delivers each version, she said.
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Rural doctors prepare to JAMIT for RMA 2013 The Australian College of Rural and Remote Medicine (ACRRM) is running an inaugural Just a Minute Instant Tutorial (JAMIT) competition on telehealth and eHealth topics for the Rural Medicine Australia 2013 conference. The conference, organised in conjunction with the Rural Doctors Association of Australia (RDAA), is being held in Cairns from October 31 to November 2. The JAMIT competition involves the creation of 60-second videos demonstrating a tip for rural doctors to help better provide telehealth or eHealth-related services. The competition is part of a workshop on eHealth and social media being held on Friday, November 1 at the conference, organised by ACRRM’s social media expert group (SMEG). SMEG members including Marion Davies, Gerry Considine, Ewen McPhee, Dennis Pashen and Mel Clothier will discuss social media, free open access medical education, telehealth and electronic health records and promise that the workshop will be a PowerPoint free zone. SMEG members Tim Leeuwenburg and Minh Le Cong have uploaded some demonstration JAMIT videos to ACRRM’s JAMIT YouTube channel, explaining rapid sequence intubation and how to do an adrenaline infusion. Dr Considine will perform his charttopping JAMIT The Musical before the competition’s judging takes place. A People’s Choice award will be presented to the video with the highest number of votes, and the SMEG will present an experts’ award for the video deemed the most relevant, clinically valid and innovative.
Telehealth can be offered in pharmacies through clinical software in the cloud eHealth solutions firm REND Tech Associates has formed a partnership with telehealth company TeleMedicine Australia (TMA) to enable telehealth consultations to be carried out in community pharmacies with secure access to clinical software in the cloud. TMA offers a suite of telehealth services, including a bank of GPs, specialists, nurses and allied health professionals who provide remote video consultations. It also markets a range of telemedicine devices, including the HiCare device, which allows patients and healthcare professionals to conduct a video conference through the device from anywhere in the world. HiCare also allows measurements from wireless-enabled medical devices such as glucometers, blood pressure cuffs, oximeters, thermometers, tests for cholesterol and HbA1c levels, ECGs and spirometers to be recorded and graphed over time. REND Tech last year launched its Cloud for Health service, aimed at allied health professionals as well as solo and mobile GPs or those working from home to use clinical software packages like Best Practice through the cloud.
The two companies have come together to provide a new service called Pharmacy-Link, in which a HiCare device can be installed in a community pharmacy through which patients can both speak to a general practitioner and have their measurements taken by the peripheral devices. “The idea behind Pharmacy-Link is to bring 24/7 GP, specialist and allied health telehealth services to pharmacies around Australia,” TMA managing director, Ash Collins, said. “This solution also allows pharmacies to screen for a number of chronic diseases such as diabetes, hypertension, dyslipidemia, atrial fibrillation and asthma. Some of the services, such as specialist medical consultations, are bulk-billed.” While the doctor is conducting the consultation, they can log in to the patient’s medical record, check their history and pathology results and, if necessary, write a prescription and send it to the pharmacist. REND Tech’s cloud service allows the script to be printed out at the pharmacy while the patient is there. REND Tech technical consultant Rob Khamas
said as his company hosts software like Best Practice in the cloud, the doctor simply has to log in and they can see the patient’s full medical history while they are doing the consultation. “The patients are remote so why shouldn’t your doctors be remote as well, so you are not limited to only offering this service from a particular location. You can bring more doctors on board including those who want to work from home or those who travel.” The idea is for pharmacists to install one of the devices and offer it as an extra service to customers, particularly in rural and remote areas. Community pharmacies can also use the device and the peripherals for screening and risk assessments and disease state management for diabetes and cardiovascular and respiratory diseases, services for which pharmacists are eligible for Primary Health Care incentive payments. Pharmacy customers can have their measurements taken in-store, and for a $20 fee have the results analysed by an online doctor in real time via the HiCare device. The patient also registers to use the service through the device while in the pharmacy.
Embarcadero releases app development platform for Android devices US company Embarcadero Technologies has added support for Android to its RAD Studio app development suite, allowing developers to design apps that can run like native apps on multiple devices and languages. Embarcadero released RAD Studio XE4 in April, allowing developers to use one code base for devices including the iPhone, iPad, Windows Slates and Surface Pro tablets, along with Mac OS X and Windows PC applications. It has now added Android as part of the XE5 release. The company recently surveyed 221 Australian developer firms, the vast majority of which developed applications for Windows, as well as for an average of one other device, including
iOS (iPhone/iPad), Android, Macs, Linux, Windows Phone and Windows Slate/Surface Pro, and Blackberry.
iOS support, and a lot of people said that’s great but call me when you can do Android. It’s interesting news for Apple.”
However, most respondents to the survey said they would like to be able to deploy applications to an average of around three devices other than Windows, including 81 per cent for Android.
While there are no figures available for the healthcare market specifically, there is no reason to think Android might not now challenge iOS in the device market for doctors, who were very early adopters of Apple devices.
Malcolm Groves (pictured), Embarcadero’s Sydneybased senior director for the Asia Pacific and Japan, said it was “astonishing” how quickly Android has begun to challenge iOS. “We see this across the board when we go into large companies and into small companies,” Mr Groves said. “We got a good response when we did the
“Part of the issue is that Apple was very early to market with the iPad, the tablet market, and a lot of adoption happened there,” Mr Groves said. “It’s a good device and it was the only player. Embarcadero worked with Hitachi Medical, which has developed a Windows desktop solution for dentists. Called Delta View, it allows dentists to show medical information like x-rays to patients and talk through any procedures with them. Rather than drag a PC over to the patient, dentists naturally wanted to be able to use the app on an iPad, but being Windows-based, this is normally a complex thing to do. By using RAD Studio, Hitachi was able to use the same code for both devices, and to design an app for iOS within a month and have it accepted on iTunes within three.
Department of Health loses ageing, picks up sport The Department of Health and Ageing has been renamed the Department of Health (DoH), with the new government confirming that the aged care portfolio will move to the new Department of Social Services. In its administrative arrangement order signed today by the Governor-General, the federal government announced that sports policies and programs will be managed by the Department of Health “to increase the focus on the importance of participation and exercise to improving health”. The new Minister for Health, Peter Dutton, will also become responsible for the National Mental Health Commission with a view to allowing a greater engagement with the mental health policies and programs managed by that portfolio. Mr Dutton will be known as the Minister for Health and the Minister for Sport, but the government has dropped the title of Minister for Mental Health instituted by the previous government. Mental health is now a part of the overall health portfolio, as is medical research. There is also no dedicated Minister for Ageing, with responsibility for aged care falling to the Assistant Minister for Social Services, Victorian Senator Mitch Fifield. The Department of Human Services, which handles the delivery of Medicare services, is part of the overall social services portfolio. The new minister is NSW Senator Marise Payne. In addition to aged care, the Department of Social Services will also handle ageing research and the National Disability Insurance Scheme. The long-serving secretary of the Department of Health, Jane Halton, remains in her position.
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BEST PRACTICE: CLINICAL MODULE FOR EXISTING USERS Melbourne, VIC p: + 61 7 4155 8888 w: www.bpsoftware.com.au
GENIE: MAINTENANCE AND REPORTS Sydney, NSW p: + 61 7 3870 4085 w: www.geniesolutions.com.au
HISA QLD: HIC 2013 QUEENSLAND REPRISE Brisbane, QLD p: +61 3 9326 3311 w: www.hisa.org.au/events
HISA NSW: PATHOLOGY INFORMATICS & RESEARCH INITIATIVES Sydney, NSW p: +61 3 9326 3311 w: www.hisa.org.au/events
GENIE: MAINTENANCE AND REPORTS Brisbane, QLD p: + 61 7 3870 4085 w: www.geniesolutions.com.au
21-23 OCTOBER HIMAA 2013 NATIONAL CONFERENCE Adelaide, SA p: +61 2 9887 5001 w: www.himaa2.org.au/conference
GPA: CLINICAL GOVERNANCE Online session w: www.gpa.net.au/webinars
24-25 OCTOBER SAFE AND SECURE HOSPITALS CONFERENCE Sydney, NSW p: +61 2 9080 4090 w: www.healthcareconferences.com.au
GPA: STERILISATION: A STEP BY STEP GUIDE PART 1 Online session w: www.gpa.net.au/webinars
BEST PRACTICE: USING BEST PRACTICE MANAGEMENT AND ADVANCED TIPS AND TRICKS FOR PRACTICE STAFF Melbourne, VIC p: + 61 7 4155 8888 w: www.bpsoftware.com.au
Save the date 28
GPA: MARKETING TO YOUR MARKET Online session w: www.gpa.net.au/webinars
GENIE: SETUP, UPDATES & THE PAPERLESS OFFICE Sydney, NSW p: + 61 7 3870 4085 w: www.geniesolutions.com.au
GPA: STERILISATION: A STEP BY STEP GUIDE PART 2 Online session w: www.gpa.net.au/webinars
HISA VIC: GETS MOBILE Brisbane, QLD p: +61 3 9326 3311 w: www.hisa.org.au/events
BEST PRACTICE: ADVANCED TIPS AND TRICKS FOR PRACTICE STAFF Sydney, NSW p: + 61 7 4155 8888 w: www.bpsoftware.com.au
GENIE: APPOINTMENT BOOK AND BASIC BILLING Melbourne, VIC p: + 61 7 3870 4085 w: www.geniesolutions.com.au
BEST PRACTICE: CLINICAL MODULE FOR EXISTING USERS Sydney, NSW p: + 61 7 4155 8888 w: www.bpsoftware.com.au
BEST PRACTICE: USING BEST PRACTICE MANAGEMENT Sydney, NSW p: + 61 7 4155 8888 w: www.bpsoftware.com.au
Online Calendar: To view a comprehensive list of eHealth, Health, and IT events, visit: http://www.pulseitmagazine.com.au/events
Bits & Bytes
eRx gears up to launch Express app for pharmacists Electronic prescription exchange service eRx is gearing up to go live with its new Express app in late October, releasing details of the pricing structure for pharmacists using the service. eRx is offering two plans for Express, one a standard plan of $50 per month and the other a premium plan for $60, which offers extra benefits such as incorporating the pharmacy’s branding within the app and access to monthly reports on usage. The subscription fee for the service includes a Windows Surface RT tablet computer with the software installed. Consumers will be able to download the Express app onto their mobile phone and scan in the QR code that will begin to appear on prescriptions, and then send it to the pharmacy of their choice. Pharmacists will use what eRx is calling the Express Q app, a Windows 8 app that is pre-loaded onto the tablet and receives the orders from the customer’s mobile phone. eRx’s business development and customer operations manager, Markus Windhofer, said the Q app is installed on the tablet, which can sit adjacent to the dispensary terminal. “The pharmacist select 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 said. Mr Windhofer said eRx was 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.
CHI to hold conference on integration for innovation in health UK-based telecare specialist Kevin Doughty and South Australia Health CIO David Johnston are two of the keynote speakers at the Innovation in Health conference being organised by the Australian Centre for Health Innovation (CHI) in Melbourne in October. CHI clinical director and conference host Keith Joe (pictured) said the focus of the two-day conference would be on innovation in health from an integrated perspective, including people, clinical processes, IT and physical environment. CHI, a not-for-profit business unit of The Alfred Hospital, runs a simulation and education centre with a mock ward and theatre environment to allow IT vendors to understand health, and for healthcare providers to be exposed to contemporary IT solutions. Dr Joe said the conference is not focused purely on IT but on increasing the understanding of the interplay between technology and the built environment. “The strength of the conference also lies in the presentation of practical issues and case studies of benefits realised, and issues identified and overcome,” he said. “We recognise
that technology adoption in health is a combination of understanding clinical practice and workflow, understanding the capabilities of technology, appreciating the change management involved, and ensuring the physical environment and infrastructure is in place.” SA Health’s Mr Johnston will provide a keynote presentation on the implementation of AllScript’s integrated electronic health record in SA that is beginning to be rolled out. Dr Doughty, co-director of the Centre for Usable Home Technologies at York and Newcastle universities in the UK and associate editor of the Journal of Assistive Technology, will discuss
the business models for eHealth and assisted living that he has developed for primary and community care planning and services. David Rosser, medical director of the new 1200-bed Queen Elizabeth Hospital in Birmingham, will discuss the development of the hospital’s technology including electronic medical record, medications management and patient self-registration. He will also present his views on the change management challenges and lessons from the project. Other speakers include Carolyn Gullery, planning and funding general manager for the Canterbury District Health Board in New Zealand, whose
role includes promoting collaboration with all healthcare providers, including ambulance, general practitioners, primary and communitybased clinicians, hospitalbased clinicians and administrators. Alan Pert and Brian Kidd of the University of Melbourne’s Faculty of Architecture, Building and Planning will provide their views on the specific challenges of hospital and disability and dementia facility design.
The conference will involve a number of practical case studies, including: • The Royal District Nursing Service’s virtual nurse telehealth project, presented by RDNS project manager Matthew Tyler • The development and use of body motion sensors by Dan Ronchi, founder and CTO of DorsaVi • New options for specialist referrals by Brian Sullivan, founder and managing director
of private referral service MEDrefer • Clinical photography in the mobile era by dermatologist and PicSafe Medi codeveloper Ted Carner • Health apps using gaming techniques to engage consumers, presented by Aaron Vernon, CTO of Two Bulls. The conference will be held at the Melbourne Convention Centre on October 24 and 25. Registrations are now open.
Claydata launches browser-based telehealth package for medical practices Sydney-based eHealth systems vendor Claydata is ramping up its telehealth offering to both the aged care and specialist healthcare sectors, developing a new browserbased teleconferencing system that predates the WebRTC standard currently in development. Claydata markets the Putty range of solutions, which includes a full EHR package, a communications package for cross-platform communications and secure messaging, a front-desk package for administrative and financial transactions, and a document management package. Underlying these packages are a range of applications
and platforms, including the PuttyConnect platform for telemedicine, alerts, messages, VoIP, chat, file transfer and video conferencing, which is done through web browers.
“We see the main problem in telehealth as the ubiquity or the ease of access to the service.” Claydata founder and inventor Joseph Grace said that while browserbased teleconferencing is a technological breakthrough, there is a drawback, particularly for medical practitioners, in identifying
who the unrelated party is. Using the PuttyHealth system, the patient can be easily identified through demographic details and through its billing system. “We see the main problem in telehealth as the ubiquity or the ease of access to the service,” Dr Grace said. The patient logs in to the service through the website for the medical practice, which acts as a shopfront. Like WebRTC, the Putty system is browser-agnostic. “It is cross-platform – it doesn’t matter what browser, whether it’s a Mac or a PC or a tablet or iPad,” he said. “It’s simple for the providers as they are already on the system.”
Errant PCEHR “password” was probably an access code An Adelaide man who claimed he was emailed a “private login password” to the PCEHR probably received an erroneous personal access code (PAC) instead, the Department of Health said. ABC News reported recently that it had been contacted by an unnamed man, who said he had received an email from the PCEHR system operator about having successfully registered. The man said he had not applied for a record and that the email seemed intended for another person with the same last name. “I’m just concerned that I was sent a private login password for something that I wasn’t entitled to that potentially could seriously breach the privacy of an unsuspecting number of the public,” he told the ABC. A DoH spokesperson said the man may have been sent a PAC, which is used when consumers are signed up using assisted registration or through a Medicare office. “Despite asking, via the ABC, for the complainant to contact us, he has not done so and it is difficult to ascertain what happened in this situation,” the spokesperson said. “It is important to note that people who erroneously receive access codes cannot access another person’s eHealth record without additional personal information.” Industry sources say it is most likely that a person with the same surname was signed up during assisted registration and the registrar or the individual entered the wrong email address. Consumers can be assisted to register in a medical practice where they are a “known customer”, or by Medicare Locals or Aspen Medical staff who have been funded recently to conduct a registration drive.
PATIENT JOURNEYS: A SYNOPSIS OF HIC2013 The 2013 Health Informatics Conference (HIC 2013) set out to focus on the significant opportunities that information technologies are fostering throughout the health sector and the pressing need to achieve more through collaboration and improving the co-ordination of existing facilities and resources for leveraging ongoing and future investments.
NIGEL CHARTRES B.Sc. (Hons), Master of Business Systems Project Manager and HISA (WA) Leadership Team firstname.lastname@example.org
The 2013 conference looked at global, â€˜big pictureâ€™ perspectives and how emerging trends and influences are creating the impetus for constructive and beneficial changes in the ways healthcare is delivered to improve health outcomes for all consumers. At the international level, ongoing rapid discoveries, through the application of innovative laboratory technologies within the fast-moving frontiers of biomedicine, in conjunction with the continued clever developments in big data analytical capabilities, are driving new dimensions in personalised genomic-based medicines.
About the author Nigel Chartres is a senior consultant at 361 Degrees, a futures strategist and systems thinker, with extensive experience in all aspects of management, business planning, stakeholder engagement, project management and solutions delivery.
Australia makes significant contributions to and is a partner in many of the international endeavours. There are leading research initiatives being conducted at universities, research centres and at multinational organisations with establishments in Australia. In some areas, Australia is a world leader, as is the case with the Human Variome Project, which was initiated by a World Health Organisation (WHO) hosted meeting in Melbourne in 2006. The numerous new generation approaches are potentially giving health consumers enhanced access to vastly improved drugs and disease intervention solutions.
Significant initiatives and projects are being focused on new approaches, such as converging real-time dynamic clinical trials with ongoing patient care. For example, Kaiser Permanenteâ€™s strategic initiative in fostering the Care Connectivity Consortium with key partners is delivering tangible benefits to many thousands of cancer patients. This has been made possible through a visionary and well managed 10-year investment program.
Consumers: personal patient journeys Within the dynamic and increasingly technology-enabled environment, consumers are demonstrating assertive and demanding behaviour by applying pressure for the healthcare sector to implement the convenient and responsive service delivery models which are prevalent in other service sectors. Rising consumer expectations, in combination with the expanding burden of chronic disease, present urgent and significant challenges which are potentially orchestrating revolutionary reforms to the ways that healthcare is provided. A major feature of the conference was a focus on very personal patient journeys in the areas of oncology and mental health.
The storytellers emphasised that individual healthcare providers try to do excellent work within their particular situations, but that they are frequently impeded in being efficient and effective due to the overall health system being fragmented and largely existing in separate delivery silos. Many occasions were highlighted when the appropriate care was delayed or not given because information was not made available from one part of the system to the other. These highly emotional and at times controversial perspectives encouraged delegates to think about and debate the need to move more quickly in terms of using existing infrastructure and resources more effectively through the clever deployment of ICT. Innovative research initiatives focused on mental health service delivery, in particular for younger people, were presented and discussed as examples of using what currently exists to improve both service capacity and capability.
Continuing challenges and barriers for change
“In Australia, despite many attempts focused on changing service models, there remain significant barriers as impediments for implementing the real‑time systems convergence required for delivering collaborative and cohesive healthcare.” Nigel Chartres
Numerous recent studies, forums and reports have identified the pressing need to more effectively and quickly address and provide solutions to a range of significant issues. All of these issues were covered in their many facets by numerous presentations and workshops at the conference and are summarised here. Leadership and governance Whilst the improved cooperation between jurisdictions in the context of
the government’s health reform agenda is recognised, emphasis was placed on the need to do more and within shorter timeframes. Policy and funding models Although the previous federal government’s health reform agenda had an inherent intention to streamline policymaking and funding models, many seem to consider that very little has really been achieved.
In recent decades, it has become abundantly apparent that although ICT solutions potentially offer multi‑dimensional opportunities for transforming healthcare, they only work effectively and deliver outcomes when properly deployed in the context of appropriately structured business models. Globally, there is a growing number of excellent examples where integrated ICT solutions have delivered remarkably successful results. In Australia, despite many attempts focused on changing service models, there remain significant barriers as impediments for implementing the real-time systems convergence required for delivering collaborative and cohesive healthcare.
Dr Penelope Dash
â€œThe issues identified throughout the conference tend to demonstrate that it is the widespread and acute lack of the necessary health literacy, which is required for effectively introducing reform, that must be addressed urgently. There are two aspects to health literacy, one focused on the health consumer and the other on the health workforce.â€? Nigel Chartres
Regulatory impediments The existing complex regulatory environment is still viewed as a major issue where very little practical and beneficial change has been introduced. Productivity and performance It is recognised that quite a lot of valuable work has progressed in terms of reporting arrangements and systems that are focusing on bringing transparency and accountability to the performance of healthcare service providers. By contrast, very little has been done, using performance information, to look in any depth at productivity and to actually introduce more efficiencies into service delivery models.
Infrastructure component connectivity Whilst the lack of technical and communications infrastructure is not viewed as the major issue it was in recent times, it was emphasised that much more effort needs to be made to connect existing infrastructure components to enable better communications between healthcare service providers and so achieve more coordination of services. At the applications infrastructure level, the PCEHR is still viewed as an overall enabler for encouraging connectivity throughout the
Standards The valuable work on standards, as coordinated by the National E-Health Transition Authority (NEHTA), is recognised as fundamental and vital for enabling linked up healthcare systems. Many ongoing practical concerns remain as requiring more urgent attention. Business processes Business process reform, much of which depends upon regulatory reform, is considered one of the most significant barriers to any meaningful beneficial transformation of the healthcare sector. Socio-technical complexities Socio-technical complexities are in many ways inextricably linked to many aspects of business models and their associated business processes. So whilst some progress continues to be achieved in specific situations, the big breakthroughs can only be achieved through large scale business process reform as driven by regulatory change.
health sector. There remain significant concerns about the rate of enrolments, along with the timetable and funding arrangements for the introduction of additional functionality.
health literacy for consumers and the health workforce that any meaningful change to the health sector service delivery models will be achieved within the short timeframes now available.
Health literacy improvement
Certification: a significant health workforce enablement strategy
The issues identified throughout the conference tend to demonstrate that it is the widespread and acute lack of the necessary health literacy, which is required for effectively introducing reform, that must be addressed urgently. There are two aspects to health literacy, one focused on the health consumer and the other on the health workforce. Studies have found that there is a pressing need to look at social determinants, including correlations between health, housing ownership, education status and avoidable chronic illness. In this context much needs to done to improve the health literacy of health consumers. Within the health workforce, there are health literacy problems at all levels, including policy makers, management and service providers. Health literacy improvement strategies should be conducted in conjunction with the implementation of facilitative, collaborative and responsive stakeholder engagement models. It is only through well-designed, stakeholder-managed strategies for improving
HISA, in collaboration with the Australasian College of Health Informatics (ACHI) and the Health Information Management Association of Australia (HIMAA), launched the Certified Health Informatician Australasia (CHIA) program at HIC 2013 as a strategic initiative for fostering a more rapid recognition and embracing of health informatics as a key enabler for change. The CHIA program provides a significant opportunity for encouraging, engaging, educating and empowering the health workforce throughout Australasia to embrace change and improve healthcare service. The CHIA website and examination materials will be available online in October.
HIC 2014 HIC will return to Melbourne in 2014. The conference will run from August 11 to 14 and focus on the people and technology investments required for building Australiaâ€™s digital health future.
ONLINE APPOINTMENT BOOKING SERVICES Practices are now spoiled for choice when it comes to online appointment booking services. With the various developers of these solutions bringing a range of experiences to the space, practices may find that using multiple solutions will allow them to maximise the benefits for both their patients and the practice.
SIMON JAMES BIT, BComm Editor: Pulse+IT email@example.com
Booking services online is not a new concept and is familiar to many, thanks principally to pioneering developments in the travel and accommodation industries. Even in the relatively complex and diverse field of healthcare, there have been online appointment booking offerings available to the market for many years. However, over the past two years in particular, several new market entrants have emerged, driving increasing levels of interest amongst practices keen to use such services. This is perhaps not surprising when considered against the backdrop of ever increasing consumerisation of IT, driven in no small part by the proliferation of smart phones and other mobile devices, which have enabled even the least IT-literate consumers to make effective use of technology.
Benefits For the purposes of this article, online appointment booking services refers to solutions that allow patients to book an appointment to see a healthcare provider, eliminating – in most cases – the need for the patient to have to phone the healthcare organisation. As listed on page 44, there are numerous providers of online appointment booking services, and while
the respective offerings continue to evolve and some don’t fit as neatly into a single classification as others, they broadly fall into two categories: practice-centric and patient-centric. Practice-centric These systems are designed to enable practices to allow their existing patients to book appointments online. Typically, these solutions have placed a high priority on integration with practice management software in an effort to make the appointment booking process more efficient for the practice. This is primarily achieved by negating the need for staff to have to manually enter appointments into their practice management software, with the online booking service performing this task automatically. Rosemary Cooper, a practice owner who developed the Appointuit online booking service, says providing better service to patients and saving practice staff time were the primary reasons her company’s solution was developed. “In our own practice we were mostly interested in looking after our existing patients, not finding new ones,” Ms Cooper says. “Most practices have more issues related to turning patients away and finding new business is not usually a priority.”
Depending on the capabilities of the online booking system and the practice’s preferences, patients new to the practice may also be able to use such services, but these people may be given a limited set of appointment types or providers to choose from. Typically a patient using this type of service would visit the relevant practice’s website and fill in an online form; however, as described below, this process may also be undertaken using a smart phone app. Patient-centric Patient-centric solutions, on the other hand, have taken a bottom-up approach by creating websites that allow patients to search for available appointments in their area, across a range of healthcare facilities. This approach can best be equated with the various online hotel booking services, which effectively create a market for hotels to sell latent capacity (i.e. unbooked rooms), allowing travellers to easily browse and compare options across a
range of accomodation providers that meet their criteria. Marcus Tan, CEO of HealthEngine, says the foundation of his appointment service as a health directory was a key point of difference with other systems, and he hasn’t yet seen strong demand to have the solution integrated with practice management software. “Because we started off as a health directory, we know that for a large number of consumers the biggest issue is negotiating the health system and that’s true for doctors as well – finding specialists and allied health and that sort of thing,” Dr Tan says. “We do integrate [with some practice management software] but we have a system where you can publish something manually. “Ninety per cent of practices are still on that solution. The thinking around that, I suspect, is that a lot of practices don’t necessarily want integration.
“They say, ‘I don’t want you to touch my booking system – I still want a human being to decide and sanity check some of this stuff.’ It doesn’t suit a lot of practices to have that integration ...“
Smart phone apps With one of the primary motivations for online appointment systems being improved convenience, it’s no surprise that many of the suppliers of these services have embraced smart phones, with many online appointment solutions available to patients on Apple’s iOS devices and handsets that run Android. As these apps are free – though some require an account to be established – Pulse+IT encourages readers to take the time to download these apps and explore them in more detail for themselves. Calin Pava, founder of Doc Appointments, says that while the majority of appointments booked through his solution originate from computers, around 35 per cent are now being made through his
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 qut.edu.au/public-health
CRICOS No.00213J © QUT 2013 HLT-13-1189 19765
mobile applications, which streamlines the process for patients. “It’s easier with the app than on the computer because the app will remember your password and user name,” Dr Pava says. “It also remembers who your doctor is. And once you have made an appointment it will email you, and integrate into your calendar so you are reminded 24 hours and then one hour before your appointment.”
Selecting a solution While the requirements of each practice and the focus of each of the available online appointment booking services varies to a large degree, healthcare organisations that are interested in providing patients with the ability to book appointments online should be mindful of the following considerations: Practice software If you are interested in selecting a solution that integrates with your practice software,
Below - A selection of the online appointment booking services operating in Australia. Right - Screenshots from the iPhone apps of (from L to R) 1st Available, Appointuit, Doc Appointments and Health Engine. Appointment Booking Service
basic patient demographic and contact information is invariably stored by the organisation providing the service. While this is not an issue in itself, practices should be mindful of how this data may be used by the appointment booking service, the details of which should be outlined in their terms of service. Workflow considerations Receiving appointment bookings via the Internet will invariably require that practices evaluate some of their established practice workflows and procedures, and provide staff with additional training as required. Practices will need to consider how cancellations, changes to appointments and no-shows are dealt with, although guidance from the providers of many of the appointment booking systems suggests that major adjustments to existing workflows are not usually required. HealthEngine’s Dr Tan says that in his experience, issues relating to patients not turning up to their appointment can be
reduced as a side effect of offering patients the option to book appointments online. “No-shows are a huge problem in the services sector and some GPs complain about no-shows of up to 20 per cent, which is ridiculous,” he says. “Because of the nature of the way HealthEngine is being used, a lot of patients want to be seen by someone very quickly and there is an urgent nature to it, so there is real value. Our no-show rates are much less than one per cent.” It is worth remembering that while planning for the commencement of the online booking service in your practice is important, the volume of patients using the service will likely be modest initially, providing the practice with an opportunity to gradually adjust to new workflows. Marketing the service to patients Unless your patients are aware that you offer an online appointment booking service, they are unlikely to make use of it. Marketing to patients in the waiting
room and encouraging them to visit your practice website or download your selected appointment booking apps are relatively easy ways to build momentum for the new service. Additional features When evaluating the solutions on the market, it is worth considering what features other than online appointment booking might be offered by the provider, and whether these may be of interest to your practice. For example, OzDocsOnline’s appointment booking service is just one of a range of patient interaction functions available via its solution, with Appointuit’s service offering recently expanding to include patient recall functions. Dubbed Appointuit Engage, the recall system can interogate a practice database, allowing staff to easily send SMS or email recall notifications, which in turn direct the patient to book a corresponding appointment via the online service.
Hedging your bets As with most burgeoning industries, there is currently a large amount of fragmentation in the market and practices may decide to engage with multiple online appointment providers to increase the chance of attracting new patients by having a presence on multiple platforms, for example. Pricing models A range of pricing models have emerged on the market, some of which may be more suitable to your practice than others depending on the volume of online appointments that get booked through the system. These include per doctor per day arrangements, monthly subscription fees, and fee structures based on the number of appointments booked. In some cases, practices only pay when an appointment is made. Many of the providers offer free trial periods, allowing practices to assess the various solutions before committing, so it makes sense to try before you buy.
A STEP-BY-STEP GUIDE TO GP MANAGEMENT PLANS WITH DR PAT’S PATIENT ASSISTANCE TOOL
In August 2012, Bundaberg-based GP Dr Patrick Byrnes launched his Patient Assistance Tool (PAT), which is being distributed by and integrates with Best Practice software. Dr Pat’s PAT is a step-by-step approach to creating management plans for chronic disease, with the added benefit of patient and GP guideline summaries.
KATE MCDONALD Journalist: Pulse+IT firstname.lastname@example.org
Dr Patrick Byrnes first got the idea for creating a patient assistance tool that could be used by the patient themselves on a tablet computer in the waiting area or at home when he was at an airport. He noticed that most passengers were happy to use the automatic check-in booths for domestic flights rather than line up for an open counter. He also noticed that most elderly people seemed to have little problem with touchscreen technology once they got the hang of it. Having been thinking of setting up an easy system for creating general practice management plans (GPMPs) to assist new registrars, he hit on the idea of starting the process with the patients themselves.
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.
Dr Byrnes is a full-time GP, a senior lecturer at the University of Queensland’s rural clinical school, and has trained over 35 registrars in his Bundaberg practice. “Every six months we get a new registrar, so I am constantly reminded of how difficult it is for new doctors to approach a complex area like chronic disease management,” he says. “My background is heavily in educating the next generation of doctors and that is really where this program comes from. It comes from sound educational principles
and is designed upwards rather than just being a theory that this should work.” The patient assistance tool is based on a series of clinics covering common chronic diseases such as asthma, arthritis, atrial fibrillation, coronary heart disease, cerebrovascular disease, COPD, diabetes, chronic heart failure, chronic kidney disease, hypertension, osteoporosis and peripheral vascular disease. PAT is a touchscreen software program which is designed for tablet use and to integrate with Best Practice. The patient uses the tablet – either an iPad running remote desktop protocol (RDP) or a Windows tablet – in the waiting room to answer questions normally asked by the nurse. The questions trigger appropriate snippets of education, so the waiting room becomes a virtual consulting room. PAT can also be used by practice nurses on a normal workstation for those patients who cannot manage a touchscreen. It is all done by clicks, so there is no typing required. The process continues in the consulting room where the doctor uses PAT on his or her desktop, using click instead of touch. The fourth step is an automatically generated GPMP specifically determined
by the patient’s and the doctor’s answers. Only problem areas get into the GPMP.
How it works Dr Byrnes says he has taken a different approach to other chronic disease management tools such as cdmNet, which starts with computer extraction of data into a provisional GPMP which has to be edited. PAT, on the other hand, uses a gradual build-up approach for the GPMP. “It is called Patient Assistance Tool because it actually starts with the patient,” Dr Byrnes says. “The patient is personally involved. PAT does the patient education in small bites on each screen before they see the doctor.
“As well, there are extra education and interviewing screens at the end of the patient section that will be triggered if required. So if they don’t need education on diet they won’t get it. If they do need education on diet they get that before they come to the doctor. “The clinics are exportable and importable in XML because we have a blank template option so you can design your own clinic, for example men’s health, and export it to other interested practices. We have designed it so you can extract data for your optional performance indicators. “What my program does is it allows the the doctor to work through one step at a time. For example, for blood pressure, it
gives you the National Heart Foundation levels, and then there is a quote from a recent study which says ‘if you see people and escalate treatment you will get control’. So it tells the doctors what they should be doing, they can say yes or no, and then that goes into the GP management plan. “Then the next screen will be cholesterol and then the next perhaps calculate their absolute cardiovascular disease risk – it is just one simple task after another that has just enough information on that screen for them to deal with. They are building up the GPMP in layers. “The PAT GPMP is generated because they have actually done all of the checking,
HealthLink/Medinexus Half Page 180 x 120 Puse IT Mag
“Some of the American literature shows that many older people cope well with touchscreens if they are coached...”
a mixture of cognitive behavioural therapy and motivational interviewing. The tool interviews the patient about their smoking or exercise habits, for example, before they even see the doctor. This information is summarised in the GPMP as well.
Dr Patrick Byrnes
With the latest version, there is a quick access icon which allows the summary of the wizard to download into Best Practice progress notes. The latest wizard allows a biopsychosocial assessment to be done for chronic pain.
they have gone through it step by step, and anything that is within normal limits, PAT will just leave it out of the GPMP. Because really, there is no point in telling patients to exercise and eat correctly if they are already doing that.” PAT allows multiple clinics to run at the same time with multiple patients, the only limit being the number of touchscreens, “Some of the American literature shows that many older people cope well with touchscreens if they are coached, and with PAT, the nurse coaches them through the first five screens. We say, ‘this is how it goes, it is actually pretty simple technology and if you feel confident you can carry on’.
“You are going to get 10 or 15 per cent of people who can’t do it because of health literacy problems but all you have to do is read the screens to them. It is designed to reduce the repetitive load on nurses in chronic disease management and to conserve labour costs for CDM.”
Future proofing In the September 2013 release of the tool, Dr Byrnes has added a full audit ability, allowing downloads into Excel for any clinic’s data between any time period for one or more doctors. His design team has devised a number of interviewing wizards for the tool based on
PAT also provides an audit trail in case Medicare asks questions about the GPMP. “Every single question has a unique number and it keeps a record of every single question you have asked and what the response was,” Dr Byrnes says. “So if you get an audit from the health department you can show them the patient did 35 questions and I did 45. I might have created a GP management plan with only five things in it but I have actually checked all of these.” PAT was built to interface with Best Practice and users can alt-tab to switch between PAT and the clinical package. Using two screens is the ideal way of using the tool, he says. “You have a PAT checklist screen on one side and you are entering the data in your main program.” The PAT might also make using the PCEHR simpler. “The very first doctor’s screen says, ‘Clean your data, look at their past history, look at all of their current medical problems, check their medication’. You have to do this to be able to complete the PAT doctor section correctly anyway, so you end up with an uploadable health summary. It is future-proofed that way.” Dr Byrnes worked closely with Best Practice Software on the design of the tool, and the company now markets and supports it. An annual subscription costs $280 +GST for a full-time GP and $140 +GST for a part-time GP or registrar.
Sunshine Summit 2014 Sunshine Summit 2014 T: (07) 4155 8888, E: email@example.com, www.bpsoftware.com.au
THE DOCTORS CONTROL PANEL Melbourne GP Anton Knieriemen first designed his Doctors Control Panel (DCP) software in 2007 as a plug-in for Medical Director to reduce the amount of pop-up alerts that appear when a patient’s file is opened. New functions have been added since then and a service to allow patients to view their pathology results online is now up and running.
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DCP was initially designed to reduce the number of pop-up alerts appearing in Medical Director, but it has since evolved to provide a number of prompts for preventative care as directed by the RACGP’s Red Book guidelines, and is now compatible with additional clinical software offerings. According to Dr Knieriemen, to comprehensively encompass all script checks, MBS Item prompts and Red Book preventative care prompts via individual pop-up boxes would require over a dozen such alerts to appear. Such an arrangement would significantly effect the clinician’s ability to quickly interact with the electronic patient record for rapid data entry or script generation. Dr Knieriemen’s DCP solution is a single panel interface that unobtrusively displays a snapshot of selected clinical information. This window can be configured to pop up automatically when patient records are opened in the clinical software, or it can be manually opened using a button in the Microsoft Windows task bar. Using a ‘traffic light’ colour scheme to indicate the status of clinical measurements, clinicians are able to determine at a glance whether additional information needs to be collected from the patient and subsequently entered into the
database. Hovering over specific items on the panel with the mouse pointer triggers a pop-up bubble that provides more information about the status of the patient and the applicable guidelines. In addition to displaying information in the panel itself, the DCP utility allows statistical data analysis to be performed on the entire clinical database. Summary data relating to the practice’s performance against Red Book guidelines can be displayed in a tabular form, or rendered into a series of pie charts. It also provides a results viewer, a family viewer to check the status of the whole family, and an advanced document facility to allow rapid generation of chronic disease management paperwork. The DCP also has links to a number of offline resources that can be downloaded as PDFs as required, including the Red Book guidelines, diabetes management guidelines, the current MBS Schedule and current immunisation guidelines. Handy additional functions, such as interfaces to Skype and Google Maps, have also been included, with the latter allowing directions from the practice to the patient’s home to be displayed in a web browser for reference or printing. Maps displaying driving directions from the patient’s home
to another clinician’s practice can also be generated.
routine results, so he set up a system to distribute results electronically.
The DCP is currently compatible with Medical Director (with or without PracSoft), Best Practice (with or without Best Practice Management or PracSoft) and Medinet. Dr Knieriemen says he is open to developing compatibility with other clinical and practice management packages.
“The administrative burden became oppressive under an onslaught of phone calls,” he says. “Email was not an option as we did not want to maintain a database of email addresses or deal with distribution security.
Dr Knieriemen estimates there are over 3500 installations of the software currently in use, with the vast majority making use of both the clinical and billing functions.
“We have a policy to recall all abnormal results requiring either discussion or urgent review. The essence of our problem was distributing routine results to patients, which is about 90 per cent of what we do.”
With the ongoing development of the DCP informed by Dr Knieriemen’s own experiences in his practice, the solution now interacts with his recently launched pathology results distribution service. The DCP Results Service (www.dcpresults.com) allows clinicans to provide their patients with access to view their results via a secure online portal.
When the reports are received back from the pathologist, the doctor checks them in the clinical software as usual and the action determined by the GP – for example, No Action, Discuss or Return Urgently – is later translated by DCP to a colour-coded comment for the patient to read online, in effect becoming the guidance for the action needed to be taken by the patient.
Dr Knieriemen says he had let the genie out of the bottle in his own practice when he began to allow patients to telephone for
Extra comments entered at the time of checking are also made available for the patient to read online.
It has a safety mechanism to exclude sensitive abnormal results, with the doctor able to exclude results from being uploaded by placing a macro in the comment field or after reviewing. After checking the results in the clinical software, the GP uses the DCP to upload results and the comments to the portal, so the patient can read them online. The patient is notified via SMS that their results are available, with the SMS message containing a PIN code to access results. “Internet distribution of routine results has lot of benefits for the patients in terms of time but also for doctors and their staff when substituted for phone call result distribution,” he says. The new results service enables GP’s to audit results and determine patients who have not made an appointment or attended. The DCP is free to trial for a month and is simple to install from the website. Premium features of the DCP related to billing guidance and EPC document creation require an annual $110 subscription.
INTRODUCING THE MEDICAL DIRECTOR SIDEBAR Last year, HCN announced a new feature for Medical Director, MD Sidebar, which would allow users to extend and customise the functionality of their clinical desktops. While development work relating to the PCEHR overtook HCN’s original plans for the MD Sidebar launch, the functionality is now soon to be released. Pulse+IT takes a look at what Medical Director users can expect when it arrives.
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Health Communication Network (HCN) will soon launch MD Sidebar, a platform designed to allow third-party software developers to extend the functionality of Medical Director. Originally announced in August 2012, the MD Sidebar will come pre-installed in Medical Director 3.15, which is currently in live beta testing with over 50 clinicians as part of HCN’s new beta testing program. While MD Sidebar is the most notable feature of the forthcoming release, HCN has indicated that the version will also feature improvements to correspondence management and add support for Microsoft Windows 8, Microsoft Windows Server 2012 and Microsoft SQL Server 2012. The MD Sidebar will launch with three apps, with users able to download additional apps from the MD Widget Store. Apps can then be displayed in the MD Sidebar and accessed easily as required by the user. Each clinician can customise their own MD Sidebar panel to suit their preferences, and the entire interface can be minimised or maximised as needed. While the concept of ‘sidebar’ utilities will be familiar to many general practitioners who have used or currently use the various
offerings on the market, the arrival of MD Sidebar heralds HCN’s first attempt at providing their own interface to support the third-party development of features not provided within the core of the Medical Director product. HCN has developed an application programming interface (API) framework to allow the apps to interrogate the data contained in the practice’s Medical Director database, and the MD Sidebar environment also allows the apps to write information back into the database, where it is appropriate and safe to do so. HCN’s commercial manager, Hong Nguyen, says that by making an API available, the company has provided a safe and secure environment for clinicians to ensure patient privacy. Apps installed in the MD Sidebar are able to request data and respond to a number of events through the API, including progress notes, allergy requests, diagnosis information, pathology information and prescription information. Clinicians will be able to control how they interact with the system and what information from Medical Director is passed through to MD Sidebar widgets via 17 access controls.
Launch apps While HCN expects the number of apps available to Medical Director users to proliferate once the MD Sidebar is released broadly, the company will launch the functionality with three apps.
“It’s interactive and displays the fact sheets in real time,” he says. “When the doctor types in the reason for visit or prescribes a medication within the patient’s file, relevant fact sheets will be automatically be named and accessible to print or emailed to the patient.”
Mr Nguyen says the new functionality provided in these apps is the first iteration of what is planned for MD Sidebar, which will continue to be populated with both free and paid apps in the months ahead.
The Healthshare app also allows clinicians to search for individual condition or product fact sheets. The app allows the doctor to email the patient the fact sheet or to open and print it.
“We will focus on what we do well, clinical software, and have allowed app developers to come up with innovative ways to help doctors and practices deliver better patient care,” he says. “We are also happy to speak with app developers.”
Healthshare has worked with over 70 of Australia’s leading not-for-profit health organisations including beyondblue, Diabetes Australia and the Heart Foundation, to provide patient information and education on its consumer website.
MD Clinical Prompts HCN’s medical director, Andrew Magennis, says the development of the MD Sidebar has allowed the company to improve the core Medical Director user experience by moving the pop-up prompts functionality to the sidebar under an app called MD Clinical Prompts.
Dr Magennis says there are over 500 topics in the app and more are being added. “We
made sure it was well populated before adding it to the MD Widget Store and that the information is written by authoritative authors,” he says. Image Safe HCN has also partnered with app developer Health v2 to add an image capture and sharing app to the MD Sidebar. Campbell McAuley, director of Health v2, says the Image Safe app his company has developed runs on any iOS or Android mobile device and allows users to take a photo of an area of concern on the skin such as a mole that has changed shape. The image is then directly sent to Image Safe's server in the cloud and then directly integrated into the patient's file within MD. “Patients can also upload their own photos so they can be monitored over time,” Mr McAuley says.
“If someone comes in with a bleeding nose and you open up their patient file, it will often prompt you to do things like update their vaccines, but you don’t want to be doing that right then,” Dr Magennis says. “We have moved these prompts to the sidebar so they can be viewed at any time during the consult.” Healthshare The second app that will be launched with the MD Sidebar is a free patient and GP education fact sheet application developed by Healthshare. Partners include notfor-profit organisations that provide fact sheets on medical conditions, support programs and prescribed medications. Mr Nguyen says are a number of ways that the Healthshare app can be used within the MD Sidebar.
WHA-WHA-WHAT DID YOU SAY, HUH?
YOU’RE BREAKING UP ON ME? Crackly phones lines? Calls dropping out? Hearing strange sounds? For the uninitiated, navigating and troubleshooting in the world of telecommunications in medical practice can be daunting. Practice manager Jonathan Lee describes his experience in this alien environment.
JONATHAN LEE BCom LLB Practice Manager Fairfield Central Medical Centre firstname.lastname@example.org
Hello, hello, baby, you called? I can’t hear a thing. I have got not service, in the club, you see, you see. Wha-Wha-What did you say, huh? You’re breaking up on me. Sorry, I cannot hear you, I’m kinda busy. K-kinda busy. K-kinda busy Sorry, I cannot hear you I’m kinda busy — Telephone by Lady Gaga and Beyonce OK, OK, I know – so Lady Gaga wasn’t singing about medical practice and maybe you wouldn’t use the term “baby”, at least not in that context, but for many practices, having poor quality telecommunications systems can drive most practice managers absolutely crazy.
About the author Jonathan Lee is the practice manager at Fairfield Central Medical Centre in Sydney. He is a lawyer and a committee member of the Australian Association of Practice Managers (NSW), and is passionate about the use of technology to improve practice operations.
In most circumstances, making a basic telephone call is probably the simplest process to describe to a doctor or staff member – “pick up handset, dial number, start talking” – simple! In fact, so simple that it is often hard to understand why something so easy can become so complicated. However, for many large multidisciplinary centres, behind the humble phone call sits a complex web of telecoms infrastructure,
equipment and software that may include a sophisticated private automatic branch exchange (PABX) system.
Practice background Fairfield Central Medical Centre is a large multidisciplinary practice with 11 FTE practitioners (GPs and specialists), allied health and support staff – a total team of more than 35 people. We provide mainly bulk-billing medical services to the south‑west Sydney community. In order to maintain a high standard of care, we need to run a very efficient and lean operating model, and that includes investment in decent IT and telecoms infrastructure. There are many areas where you can save money and cut costs, but these days, computers and telephones are mission-critical. Many practices often learn the hard way by underinvesting in key infrastructure and finding they are dealing with computer or telephone issues in an ad hoc manner. Our internal reports show that we were handling approximately 5000 to 6000 telephone calls per month, with calls averaging approximately one minute each. With 22 working days per month (including half-day Saturdays), we handle over 250 calls a day, most of which are
inbound calls. Outbound calls – recalls, appointment reminders etc – have been steadily increasing as the patient base grows.
messaging, SMS, email, staff meetings and practice noticeboards. You need to be clear as to which channel is used for what purpose.
When I first started in practice management, my mandate was simple. The practice was growing rapidly and needed modernisation to allow for continued practice growth without a noticeable disruption to patients, staff and practitioners. Firstly, an IT investment was required – now successfully implemented, stable and quite speedy (thankfully!).
What gear do we use?
Secondly, the communication channels in the practice needed review. The one‑on‑one nature of medical practice means that it is absolutely essential to establish robust and clear communication channels between members of a team – between doctors, nurses, staff, allied health, accountants and IT. For our practice, a key communication channel is verbal communication via a telephone call. Others include internal
As it currently stands, our system comprises of: • Avaya IP Office 500 PABX system with digital handsets (that require a phone server as opposed to analog handsets that might simply plug into the wall socket). A PABX is essentially a telephone switch that can manage multiple external lines while providing a range of internal extensions. • More than 40 extensions using Avaya 5410 handsets, which are robust and simple with some handy features. • Nine PSTN lines (analog copper lines) – one lift, one fire and seven ‘useable’ lines for incoming calls. • Four Voice over Internet Protocol (VoIP) lines – lines provided over the internet – for certain outgoing calls.
At the time of installation, this was the most cost-effective combination. Modern PABX systems can be very powerful but also expensive and complicated to troubleshoot. Nevertheless, for practices that handle large call volumes, there are significant advantages delivered by a PABX system as it allows, for example, outgoing calls to be channeled to certain lines (eg. if certain lines are cheaper) and the flexibility to scale up the number of handsets when required. If you think of a PABX as effectively a computer that coordinates your telephone system, you can start to appreciate the potential impact a well set up and streamlined PABX system can have on day‑to-day operations. On the negative side, such a system will require more maintenance and management. The key takeaway is that you need to approach any telecommunications investment in a similar manner to an IT investment.
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“If there are problems with poor infrastructure and call quality, it not only adds cost via operational inefficiencies, but also mental stress to frustrated practice staff and doctors.” Jonathan Lee
So what’s the problem? Soon enough, we quickly discovered that our reliance on analog copper lines was no longer sufficient for our needs. The practice started experiencing issues with poor call quality, call drop-outs, cross talk and strange background sounds that cannot be explained. Patients were complaining of calling in and hearing us but we were not able to hear them. Strange clicking sounds could also be heard on certain calls. If there are problems with poor infrastructure and call quality, it not only adds cost via operational inefficiencies, but also mental stress to frustrated practice staff and doctors. Telephone calls are expensive. Although the actual call costs may be minimal, do not underestimate the costs of labour to process calls and the opportunity cost of productive time that can be applied to more value-adding activities. For example, the process of booking straightforward appointments made over the phone by patients (who could otherwise make appointments themselves via other means) is in reality a non-value adding activity. What you will find is that ‘hidden’ costs start to build up and are more noticeable as your practice grows and you find that your staff is spending more time handling
telephone calls and not having time to do other important tasks. Primary health is a ‘shop front’ business that requires high uptime and high availability during opening hours and problems with telecoms infrastructure can severely affect patient throughput. In order to better assess the true impact, it may be worthwhile to invest in ‘call accounting’ software to allow the collection of statistics from your phone system.
Troubleshooting This is where it started getting tricky and messy. Where do I start? Where could the problem be? Because our telephone lines are not the ‘traditional’ analog set-up, it became extremely difficult to identify the bottleneck and source of the issue. Was it the handset itself? Possible. Was it the PABX hardware? Possible. Was it the internal cabling? Possible. Was it the external cabling from Telstra? Possible. Troubleshooting a telecoms fault is a bit like troubleshooting an IT problem but without the continuous packets of data and the visuals of a computer monitor. Very often, you need to trace the call and investigate the actual cabling by waiting for a call to be placed (or received) before capturing the point of error. Calls are short. Calls are sporadic. Capturing short and sporadic data is like catching a mouse in the dark by waiting for it to squeak.
We engaged a private telecoms contractor who undertook some investigations. Handsets were replaced. Port cards were replaced. Software was upgraded. It seemed that our hardware was fine and the cabling seemed OK. We had diligently concluded that the problem was with the main line infrastructure coming into the premises. However, because Telstra is only responsible for the infrastructure up to the main distribution frame (MDF) in the premises – and Telstra had determined there was nothing wrong with the infrastructure despite the external “pit” looking so ridiculously archaic and the “pillar” so ugly to scare even Dr Who – it became a battle of who should be responsible for further investigating the fault. I will save you all the details of what happened next as it would end up becoming a War and Peace version of events, but essentially, it became evident that we had to find an alternative to our existing set-up and our reliance on analog PSTN lines. The alternatives will be discussed in a future edition of Pulse+IT.
Key takeaways • Establish your priorities when assessing practice communications channels. How important is the telephone call to your practice? • Approach any telecommunications investment as you would for your IT infrastructure. It can be a steep learning curve to appreciate all the ‘moving parts’. • Modern PABX systems are very powerful but require a greater financial investment and can be more complicated to troubleshoot. • Different telecoms technicians specialise in different systems. • Know where the MDF and key infrastructure is located inside and outside your premises.
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PCEHR RESOURCES AT YOUR FINGERTIPS The newly elected Coalition government has signalled it will review the operation of the PCEHR but it seems unlikely that it will scrap the system altogether. With NEHTA figures showing that just on half of all general practices in Australia have registered to use the PCEHR, for those still hedging their bets, here is a quick guide to getting started.
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Since it went live in July last year, Pulse+IT has covered the operation of the PCEHR extensively, talking to government officials, technical experts, software vendors, industry and professional associations and, more importantly, the clinicians and healthcare providers who are using or are preparing to use the system. The vast majority of those we have spoken to have expressed two views very clearly: one, the long-term benefits of eHealth for patients are a worthwhile goal; and two, the processes for registering to use the PCEHR are onerous and unnecessarily complex. Recent figures released by the National E-Health Transition Authority (NEHTA) show that as at July 10, there were 3723 general and multidisciplinary practices registered in the PCEHR system, which NEHTA says covers an estimated 53 per cent of total general practices in Australia. There are also 72 Aboriginal Medical Services registered, along with 70 community health centres and seven aged care facilities. Community pharmacy participation is still low at only 271 outlets registered, and acute care registration is very low, with only three private and eight public hospitals signed up. (These figures are from early July, and it is understood
that many more hospitals are now being registered, including nine in South Australia.) General practice was always the prime focus for rolling the system out, and it is where most of the problems and issues with the system have become apparent. The main bone of contention – besides its clinical usability – is the difficulty in signing up in the first place. These problems have since been repeated in our discussions with Aboriginal-controlled health services and the aged care sector. For those practices that are still intending to take part, a vast wealth of resources has been prepared. These resources should make it easier for the late developers than the early adopters.
Health and Human Services As the system operator for the PCEHR, the first point of call for any practice should be the Department of Health’s ehealth.gov. au website. Due to the confusion over the number of acronyms used – HI Service, IHI, HPI-I, HPI-O, NASH – it is helpful to select one person at the practice to begin the process. That person will invariably go on to become the Responsible Officer (RO), who must be registered as such before joining the system.
While the resources of the Department of Health (DoH) or NEHTA itself should be the first point of call, many we have spoken to have found the advice provided by these organisations as either too consumeroriented – in the case of the department – or technically complex, in the case of NEHTA. DoH has responded to these criticisms and has provided some very easy to use steps on the Public Learning section of its ehealth.gov.au site. It has also published a good checklist to guide new users through the complexity. The department has links explaining all of these steps on its website. It is still a slow process, however, and numerous organisations have reported being overwhelmed with paperwork. While DoH is the system operator, the Department of Human Services deals with many of the registration steps, especially the HI Service. The DHS website also contains all of the forms required to participate in the system, including information on the Healthcare Provider Directory, contracted service providers (CSPs), and reference guides to organisational type classifications. DoH and DHS resources • PCEHR website: www.ehealth.gov.au • Getting your practice ready: http:// publiclearning.ehealth.gov.au/hcp/ how-do-we-get-ready/getting-yourpractice-ready/ • Quick guide to getting started: http:// publiclearning.ehealth.gov.au/pdf/ getting_your_practice_ready/gypr_ quick_guide.pdf • Medicare forms: http://www. medicareaustralia.gov.au/provider/ health-identifier/index.jsp
There are separate sections on the site for software vendors and IT professionals, but it also contains some quite good information for healthcare providers as well. It recently published a General Practice Registration Workbook as downloadable PDFs from the website, which explains the ePIP incentive and the five requirements, an overview of eHealth for practice managers and a guide to using the HI Service, as well as a number of guides for applying to register for the PCEHR. It also provides guides for applying for a NASH PKI certificate, a guide to applying to register for the PCEHR through Health Professional Online Services (HPOS), as well as a guide to the participation agreement and sample eHealth policies. While it was slow to provide this information initially, the General Practice Registration Workbook is probably the most comprehensive resource available. It has also developed a Pharmacy Registration Workbook and another for other healthcare provider organisations. The NEHTA website also has a host of information on the other eHealth elements
such as secure messaging, electronic transfer of prescriptions and clinical terminology, along with good descriptions and samples of the different clinical documents being used, such as shared health summaries, event summaries and electronic discharge summaries. NEHTA is also responsible for the register of compliant software at the PIP eHealth product register, which allows practices to check if the vendors of different components of the system – including clinical and practice management software packages, secure messaging service providers and electronic prescription exchange services – are compliant with the PCEHR. NEHTA resources • Registration information: http:// www.nehta.gov.au/our-work/ implementation-and-adoption/ehealthregistration-support • General Practice Registration Workbook: http://www.nehta.gov. au/our-work/implementation-andadoption/ehealth-registration-support/ general-practice-registrationworkbook • ePIP product register: https:// epipregister.nehta.gov.au/
NEHTA NEHTA revamped its website earlier this year and has made its PCEHR section much more comprehensive and easy to navigate.
“NEHTA revamped its website earlier this year and has made its PCEHR section much more comprehensive and easy to navigate.” Kate McDonald
Membership organisations DoH has worked closely with the professional colleges and industry associations to help create resources to guide members through the process. Early on in the process, the Australian Medical Association (AMA) realised that there was a great deal of confusion out there, so it created a full guide to using the PCEHR, accompanied with a checklist to sign off as practices went through the process. In association with NEHTA, the AMA has published the AMA Guide to Using the PCEHR, which is available to download from its www.ama.com.au under the resources tab. It has also created a very good guide to applying for the eHealth Practice Incentive Payment (ePIP) and what each of the five steps are that practices must complete to qualify. The online checklist provides links to the various authorities practices must apply to, including DoH and DHS Medicare. The Royal Australian College of General Practitioners also has a wealth of information on the eHealth section of its site, including a preparatory guide to getting started. It has also developed a number of webinars, hosted by doctors, that explain the workings of the system in a clear format.
The Australian College of Rural and Remote Medicine (ACRRM) also provides some helpful links to the PCEHR and the ePIP on the eHealth section of its website at www.ehealth.acrrm.org.au. The Australian Association of Practice Managers (AAPM) has been involved in distributing information on the PCEHR since its inception, and has built up a host of resources for practice managers on how to register both the practice and the practitioners. AAPM provides a downloadable brochure on eHealth for practice managers, a user guide to the HI Service as well as some “mythbusting” guides to applying for the ePIP. The AAPM also provides some useful links to other resources, including those detailed here. Membership organisation resources • AMA Guide to Using the PCEHR: https://ama.com.au/ama-guide-usingpcehr • AMA PIP eHealth and PCEHR checklist: https://ama.com.au/getting-ready-pipehealth-incentive-and-pcehr • RACGP resources: http://www.racgp. org.au/your-practice/e-health/ ehealthrecords/pcehr/preparation/ • ACRRM eHealth: http://www.ehealth. acrrm.org.au • ACRRM ePIP: http://www.ehealth. acrrm.org.au/pip-ehealth-incentive • AAPM eHealth: http://www.aapm.org.
au/resources/ehealth.aspx • AAPM resources: http://www.aapm. org.au/about-aapm/links-otherresources.aspx
Medicare Locals In addition to eHealth information on each Medicare Local website, the Australian Medicare Local Alliance (AMLA) also has a dedicated eHealth section, which includes information for healthcare providers on the eHealth record system for healthcare professionals and the eHealth record system evolution. It also has sections on understanding privacy and security, clinical information systems and eHealth records, registering for the eHealth record system, preparing data, changing roles and responsibilities, potential uses and how to access and use the provider portal. It also provides presentation packs to publicise the system to practices and to assist patients in understanding it, although these are predominantly for Medicare Local use. AMLA resources • Resources for Medicare Locals: http:// amlalliance.com.au/medicare-localsupport/ehealth
Software vendors As the general practice and medical specialist software vendors have worked closely with NEHTA and DoH to establish the system and integrate it within their products, it is no surprise that the vendors themselves are a great source of practical information on the PCEHR. While they mainly provide information on configuring their software and accessing the system from within their solutions, they also provide links to other sources of information such as the DoH, NEHTA and DHS websites.
ACSS AAPM P: 1800 196 000 / +61 3 9095 8712 F: +61 3 9329 2524 E: firstname.lastname@example.org W: www.aapm.org.au The Australian Association of Practice Managers (AAPM) is a not for profit, national peak association founded in 1979, dedicated to supporting effective practice management in the healthcare sector. The Australian Association of Practice Managers: • Represents practice managers and the profession of practice management throughout the healthcare industry. • Promotes professional development and the code of ethics through leadership and education. • Provides specialised services to support quality practice management including advocacy, education, resources, networking, advice and assistance.
P: 1300 788 005 / +61 2 9632 0026 F: +61 2 9632 0096 E: email@example.com W: www.acsshealth.com ACSS provides innovative and customisable patient management software streamlining day-to-day operations for GPs, Allied Health, Specialists, Radiologists, Pathologists, Private and Public Hospitals. eClaims® — Comprehensive and robust appointment and billing system with digital/voice recognition capabilities, electronic reporting transmissions and HL7 PACS system integration. eClaims® Hybrid — A solution tailored to Hospitals and other health service providers including billing agents who lack online capabilities. eClaims® Hybrid is the interface solution for connecting you to Medicare and health funds through ECLIPSE. SimDay® — Proven PAS (Patient Administration System) specifically designed for day surgeries and private hospitals – Now with ECLIPSE integration.
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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.
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The medical range extends through: • Point-of-Care Terminals. • Mini-PC and Medical Imaging Displays. • Mobile Medical Tablets. • Computerised Medical Carts. • Patient Infotainment Terminals.
Contact: Emma Pate firstname.lastname@example.org
Advantech is also an official distributor of Microsoft Windows Embedded software across Australia & New Zealand.
University trials show cdmNet results in improved quality of care and better patient outcomes.*
cdmNet eliminates paperwork and makes compliance with Medicare requirements easy. It increases the productivity of the entire practice and allows evidence-based care to be delivered to all chronically ill patients. If you wish to use cdmNet to provide high quality care for all your chronically ill patients while increasing your revenues, contact us now. • See cdm.net.au/evidence
Cerner Corporation Pty Limited
Best Practice P: +61 7 4155 8888 F: +61 7 4153 2093 E: email@example.com W: www.bpsoftware.com.au Best Practice sets the standard for GP clinical software in Australia offering a flexible suite of products designed for the busy GP practice, including: • Best Practice Clinical (“drop-in” replacement for MD) • Integrated Best Practice (Clinical/ Management) • Best Practice Automatic SMS reminders Visit us at the following conferences throughout the year: • RACGP Darwin, 17-19 October • GPCE Melbourne, 15-17 November
P: +61 2 9900 4800 F: +61 2 9900 4990 E: AsiaPacific@cerner.com W: www.cerner.com.au Cerner is one of the leading global suppliers of health care information technology solutions. Cerner’s mission is to contribute to the systematic improvement of health care delivery and the health of communities. Our vision of proactive health care management drives innovation in the development of effective solutions for today’s health care challenges, while creating a foundation for tomorrow’s health populations. Working with more than 4000 clients worldwide, Cerner is solving health care’s many challenges making sure the right people have the right information at the right time. Our innovative leadership is allowing us to push boundaries by: • Leveraging clinical and pharmaceutical data in Condition Management and Personalised Medicine • Connecting the community with personal and community health records
CONNECT DIRECT Pty Ltd Clintel Systems P: +61 8 8203 0555 E: firstname.lastname@example.org W: www.clintel.com.au The Specialist: A complete solution for your Appointments, Billing including Online Claiming and Clinical requirements in an intuitive scalable solution. Clintel provides systems to Specialist and Day Surgeries nationally. Powerful, highly configurable and easy to use, our systems mirror the needs and workflow of your practice and individual specialty. Our industry standard SQL database enables a true “paperless” practice. Our leading edge architecture is future proof, it is designed to meet changing requirements and offers first class reporting and analysis of clinical and business data. Standalone or networked multi-site installation which runs on both Mac OSX and Windows operating systems. Our support is first class, our philosophy is “whatever it takes”.
Cutting Edge Software P: 1300 237 638 E: email@example.com W: www.cesoft.com.au Cutting Edge produces affordable, intuitive billing solutions for Mac, Windows, Linux and iPad. Cutting Edge is ideal for practitioners who prefer to maintain control of their own billing from a number of sites. Cutting Edge Software is approved by Medicare Australia to manage your electronic: • Verification of Medicare and Fund membership • Bulk Bill and Medicare claims • DVA paperless claims • Inpatient claims to Health Funds We have solutions tailor-made for: • Anaesthetists • Surgeons/Surgical Assistants • Physicians • GPs • Allied Health The software comes with up-to-date schedules for MBS/Rebate, Gap Cover (all registered health funds), Workers’ Compensation, Transport Accident authorities and DVA.
Cloud9 Software P: 1300 875 297 F: +61 2 9715 6573 E: firstname.lastname@example.org W: www.c9s.com At Cloud9 we understand the complexity of healthcare. We understand the importance of having the right information available when and where it’s needed. So Cloud9 created an eco-system to connect healthcare providers that supports the availability of key information to improve outcomes for the patient, clinician and organisation alike. An information infrastructure with real-time access across primary, community and acute setting benefits Clinicians trying to provide the best care for individuals as well as Researchers looking to improve safety and effectiveness of treatments. Our e-Health infrastructure has been designed to fit in with your current systems, whilst Cloud9’s next generation administrative and clinical applications allow you to upgrade existing systems as your business grows. Cloud9 Solutions: • Cloud9 Spine, Health Information Exchange • Synchronicity, Application Integration Suite. • Clarity for GP’s and Specialists. • Clarity Hospital Information System.
Digital Medical Systems P: 1300 865 977 F: +61 3 9753 3049 E: email@example.com W: www.dgs.com.au EASIER MEDICAL IT is a technology partnership with DMS – we make IT work for you. DIGITAL MEDICAL SYSTEMS has provided ICT solutions and services to medical practice clients across Australia since 1990. We have specialist expertise and experience in the installation and support of all Australian leading medical software applications. DMS is a Business Partner for IBM, LENOVO, HP, CISCO and Microsoft. Other leading ICT brands include Webroot Secure Anywhere, StorageCraft, CA, Toshiba, Canon, Epson, Kyocera, Fujitsu and Brother. Accreditation is easier with the customised DMS IT Systems Policy and Procedures Documentation. This ensures your practice has the best IT policy, security and maintenance program that meets and exceeds the standards guidelines from the RACGP.
Direct CONTROL is an affordable, intuitive and educational Practice Management System for providers of all disciplines with seamless integration with Outlook, MYOB or QuickBooks and Medicare Online. The Clinical Module manages Episodes of Care including State, Federal and Health Fund Statistical Reporting for Day Surgeries/Hospitals. 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, Anaesthetists, Pathologists, Radiologists, Day Surgeries/Hospitals). Ideal for the single practitioner or the Multidisciplinary Practice. Accommodating the needs of nearing 2000. SQL .NET for interoperability and scalability
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: firstname.lastname@example.org W: www.directcontrol.com.au
Doctors Control Panel E: www.pracsoftutilities.com W: PSU_admin@pracsoftutilities.com • Download and trial DCP software for GP’s and health teams. • DCP is your digital PA and guidelines advisor. • DCP facilitates TCA, GPMP and MHCP creation and tracking. • Contains guidelines licenced from RACGP. • Low annual subscription. • The best preventive care add-on software in Australia. • Compatible with MD3 and BP. • Achieve new heights in preventive care performance. • Significant benefit for patients. • Increase your revenues. • Streamline your workflow. • 3000 current users. • Several research projects based on DCP. • Try it today.
Emerging Systems P: +61 2 8853 4700 E: email@example.com W: www.emerging.com.au/ehealth Emerging Systems is a market leader of healthcare information and integration technology solutions. Our eHealth products and services have supported clinicians in leading Australian public and private hospitals for over a decade to deliver safe, quality healthcare. The award-winning Emerging 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. Emerging clinical mobility technology 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: firstname.lastname@example.org W: www.extensia.com.au Extensia links healthcare providers, consumers and their communities for better and more efficient health care. The products used to do this can be custom branded for all Organisations and include: • RecordPoint – a proven Shared Electronic Health Record that links all clinical systems, hospital settings, care plan tools and any other sources of information available. It provides a secure means of sharing critical patient data in a privacy compliant and logical structure. • EPRX – an Electronic Patient Referral Exchange and Directory. It streamlines the process of selecting a provider and completing a referral. Patient information is transferred seamlessly from clinical software. The most relevant providers, services and products are presented instantly and referral documents are generated and sent electronically.
GPA P: 1800 188 088 F: 1800 644 807 E: email@example.com W: www.gpa.net.au GPA ACCREDITATION plus (GPA) is the only independent accreditation program for general practice in Australia. Established in 1998 and run by a team of committed general practitioners, business leaders and experienced administrators, GPA has developed a program that continuously evolves in order to set new standards in general practice accreditation, while offering full support to practices to make accreditation both achievable and rewarding.
P: +61 2 8985 6688 / 1300 799 904 E: firstname.lastname@example.org W: www.episoft.com.au
GPA is committed to providing an accreditation program, which is flexible and understands the needs of busy GPs and practice support staff. Whilst accreditation gives practices access to the Practice Incentive Program (PIP), GPA believes it should offer benefits that go well beyond the PIP. Our program provides practices with a pathway to enhanced patient care, continuous professional satisfaction, improved practice efficiency and superior risk management. GPA ACCREDITATION plus certificates and signage remind patients that their practice has achieved a level of care and service above and beyond essential general practice standards.
EpiSoft’s web based platforms deliver dual purpose systems that work as comprehensive clinical and practice management platforms together with clinical trials software facilitating multi-centre investigator initiated trials. EpiSoft has developed platforms for: • Mental Health • Cancer management & surveillance • Inflammatory Bowel Disease • Hepatitis • Indigenous chronic disease management • Asthma shared care • Specialised surgery • Pre-admissions patient portal
GPA provides a system designed to accommodate busy general practices. Among our services, we offer practices the opportunity to use technologicallyadvanced, environmentally-friendly online programs, allowing staff to upload documentation at their own pace; individually assigned client managers, supporting practices through accreditation from start to success and beyond; highly-trained and sensitive surveyors, with extensive experience in all facets of general practice; and interactive training seminars, bringing practices the latest information in standards and innovation.
Affordable and scalable, EpiSoft is used in health organisations ranging from small clinics to large hospital groups across Australia, New Zealand and Singapore. Create multidisciplinary teams, collaborate effortlessly and streamline workflows with our intuitive cloud software. With the highest level of security, redundancy and reliability your data will be accessible anytime and anywhere.
Genie Solutions P: +61 7 3870 4085 F: +61 7 3870 4462 E: email@example.com W: www.geniesolutions.com.au Genie is a fully integrated appointments, billing and clinical management package for Specialists and GPs. Genie runs on both Windows and Mac OS X, or a combination of both. With over 2800 sites, it is now the number one choice of Australian specialists.
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: firstname.lastname@example.org W: www.hcn.com.au Health Communication Network (HCN) is the leading provider of clinical and practice management software for Australian GPs and Specialists and supplies Australia’s major hospitals with online Knowledge resources. HCN focuses on improving patient outcomes by providing evidence based software tools to health care professionals at the point of care. Market snapshot: • 17,000 medical professionals use Medical Director • 3,600 GP Practices use PracSoft • 800 Specialist Practices use Blue Chip and • 2,100 Specialists use Medical Director • Leading suppliers of Knowledge Resources to Australia’s major hospitals
Health Informatics New Zealand E: email@example.com W: www.hinz.org.nz Health Informatics New Zealand (HINZ) is a national, not-forprofit organisation with a focus on collaboration, education and advocacy for the use of IT in the health sector. HINZ enables professional collaboration through conferences, seminars and an interactive online portal, bringing together clinicians, administrators, allied health professionals and many others with an interest in health IT and the advances it can enable. HINZ provides a platform to share information about the Health Informatics industry - leveraging best practice from New Zealand and overseas, as well as facilitating networking activities to bring industry experts and interested parties together to collaborate. Membership is for anyone with an interest in Health Informatics.
Health Informatics Society of Australia P: +61 3 9326 3311 F: +61 3 8610 0006 E: firstname.lastname@example.org W: www.hisa.org.au HISA is Australia’s health informatics organisation. We have been supporting and representing Australia’s health informatics and e-health community for almost 20 years. HISA aims to improve healthcare through the use of technology and information. We: • Provide a national focus for e-health, health informatics, its practitioners, industry and a broad range of stakeholders • Support, promote and advocate • Provide opportunities for networking, learning and professional development • Are effective champions for the value of health informatics HISA members are part of a national network of people and organisations building a healthcare future enabled by e-health. Join the growing community who are committed to, and passionate about, health reform enabled by e-health.
HealthLink P: 1800 125 036 (AU) P: 0800 288 887 (NZ) E: email@example.com W: www.healthlink.net Australia and New Zealand’s most effective secure communications service. Transforming healthcare by connecting healthcare providers. • Provider of compliant Secure Messaging Delivery (SMD) services • Standards compliance delivering certainty in care • Fully integrated with leading GP and Specialist clinical systems • Referrals, Reports, Forms, Discharge Summaries, Specialist Diagnostic Orders and Reporting • Affords all healthcare providers efficiencies in reducing paper based handling • Robust; Reliable and Fully Supported • New online services including Care Insight - distributed search for clinical information • Expert partnerships with Healthcare organisations, State and National Health Services Join HealthLink and be connected with more than 85 % of Australian GPs and 99% of NZ GPs who are already part of the HealthLink community.
InterSystems P: +61 2 9380 7111 F: +61 2 9380 7121 E: anz.query@InterSystems.com W: www.InterSystems.com InterSystems Corporation provides the premier platform for software for connected healthcare, 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. It enables organizations to capture and share all patient data, and provides real-time active analytics that drive informed action across a hospital network, community, region, or nation. HealthShare facilitates strategic interoperability, coordination of care, population health management, and community engagement. InterSystems Ensemble® is a platform for rapid integration and the development of connectable applications. InterSystems CACHÉ® is the world’s most widely used database system in clinical applications.
MEDITECH Australia P: +61 2 9901 6400 F: +61 2 9439 6331 E: firstname.lastname@example.org W: www.meditech.com.au A Worldwide Leader in Health Care Information Systems MEDITECH today stands at the forefront of the health care information systems industry. Our products serve well over 2,300 health care organisations around the world. Large health care enterprises, multi‑hospital alliances, teaching hospitals, community hospitals, rehabilitation and psychiatric chains, long-term care organisations, physicians’ offices, and home care and hospice agencies all use our Health Care Information System to bring integrated care to the populations they serve. Our experience, along with our financial and product stability, assures our customers of a long-term information systems partner to help them achieve their goals.
Medtech Global Ltd P: 1800 148 165 E: email@example.com W: www.medtechglobal.com
For over 30 years, Medtech Global has been a leading provider of health management solutions to the healthcare industry enabling the comprehensive management of patient information throughout all aspects of the healthcare environment.
P: 1800 420 066 (AU) P: 0800 401 111 (NZ) E: firstname.lastname@example.org W: www.houstonmedical.net
Health Information Management Association Australia P: +61 2 9887 5001 F: +61 2 9887 5895 E: email@example.com W: www.himaa2.org.au The Health Information Management Association of Australia (HIMAA) is the peak professional body of Health Information Managers in Australia. HIMAA aims to support and promote the profession of health information management. HIMAA is also a Registered Training Organisation conducting, by distance education, “industry standard” training courses in Medical Terminology and ICD-10-AM, ACHI and ACS clinical coding.
“We provide time to health professionals through efficient practice management software” Our multidiscipline software provides interfaces to every major manufacturer, enabling many clinics to save space by becoming completely paperless! We are a progressive medical software company and take pride in working with our health care clients to deliver tailored EMR and PMS packages based on each unique situation and practice requirements. We’re focused on helping to make their businesses more efficient and productive as well as delivering measurable improvements in customer satisfaction and market share. You can arrange a free demonstration of our software by visiting: www.HoustonMedical.net
Leecare Solutions P: +61 3 9339 6888 F: +61 3 9339 6899 E: firstname.lastname@example.org W: www.leecare.com.au Leecare Solutions, with their products Platinum 5 & P5 Exec, are the aged care industry’s leading web browser based clinical and management software system. Since 2000, Leecare has provided relevant, contemporary software solutions for Australian and New Zealand aged care organisations. Leecare’s mission and products provide outstanding clinical decision making support, and management support tools that use any device, can be installed on multiple platform types and in any location. Used in over 30,000 aged care places, it is the solution used by quality providers, proven through thousands of accreditation, validation and other regulatory visits, as it is based on professional clinical and lifestyle provision concepts.
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: email@example.com W: www.mims.com.au MIMS Australia is built on a heritage of local expertise, credibility and adaptation to changing healthcare provider needs. Our information gathering, analysis and coding systems are proven and robust. MIMS information is backed by MIMS trusted, rigorous editorial process and constantly updated from a variety of sources including primary research literature. Our database and decision support modules are locally relevant, clinically reviewed and updated monthly and compatible with a host of clinical software packages. Indeed, the majority of Australian prescribing packages and many dispensing applications are supported by the MIMS medicines data base. MIMS is delivered all the ways you need – print to electronic, on the move, to your patient’s bedside or your consulting room desk. Whatever the format, MIMS has the latest information you need.
Orion Health P: +61 2 8096 0000 / +64 9 638 0600 E: firstname.lastname@example.org W: www.orionhealth.com Orion Health is New Zealand’s largest privately owned software exporter and a global leader in eHealth technology. Founded in 1993, by CEO Ian McCrae, Orion Health has grown from a specialist health integration vendor into a company that sells a comprehensive suite of eHealth solutions. Orion Health has extensive experience in the design and installation of complex systems within demanding healthcare environments. Orion Health designers and engineers work right alongside in-house clinicians in order to develop elegant and intuitive products that encourage swift adoption with minimal disruption, allowing your clinicians to focus on patients. Today, our products and solutions are currently implemented in more than 30 countries, used by hundreds of thousands of clinicians, and help facilitate the care for tens of millions of patients.
OzeScribe P: 1300 727 423 F: 1300 300 174 E: email@example.com W: www.ozescribe.com.au
MITS:Health P: 1300 700 300 E: firstname.lastname@example.org W: www.mitshealth.com.au Managed IT Services for the Health Industry MITS:Health provides a full range of IT services specifically tailored for medical centres, GPs and specialists across Melbourne. • • • • • •
Equipment supply and installation Remote monitoring and support Data backups Networking Internet Website Development
OzeScribe is the dictation and transcription solution for most Australian university teaching hospitals and major private clinics. It really does make sound business sense to let OzeScribe worry about managing dictation, transcription and technology. We provide free electronic document delivery – OzePost – to your EMR and your associates’ EMR, saving you thousands of dollars in time, packing and postage. OzeScribe is the provider of the most advanced solutions available. • Run by doctors – for doctors. • Australian trained typists. • Manage dictation and transcription via computers, iPhone, iPad, android or smartphones. • Integrated M*Modal speech recognition technology on demand.
PicSafe Medi P: +61 3 9670 9339 E: email@example.com W: www.picsafe.com The Secure Mobile Medical Imaging System Designed by Australian and US Dermatologists and Plastic Surgeons to be used by a wide range of healthcare professionals working in a variety of clinical settings, PicSafe Medi (patent pending) is as simple as using the normal camera function on your mobile smart device except... your patient’s photo is completely secure and legally compliant in its consent, transmission, and storage when taken with PicSafe... Both iOS and Android compatible, PicSafe Medi simultaneously suffices patient privacy and related government regulatory requirements (including new Federal APP’s, commencing 12th March, 2014) surrounding the capture, use, and storage of medical photographs. Using PicSafe Medi, Healthcare professionals can now quickly connect and efficiently document a patient’s status pictorially, facilitating the medical referral process and, ultimately, improving patient outcomes and satisfaction. Stored clinical photographs are fully patient-consented (including authorisation for specific usages of their photo), watermarked to assure authenticity, and managed in a highly secure, auditable, private server environment, accessible only to authenticated PicSafe users. From the time you take a patient’s photo with a smart device, to the encrypted transmission and secure storage phases of photo handling, the process is seamless and non-intrusive to both photographer and patient. • Increase your efficiency and improve your patients’ clinical outcomes • Remove the worry surrounding costly patient privacy breaches • Assure quick, efficient pictorial documentation of your patient’s status • Facilitate a streamlined medical referral process • Fully document your patient encounters for billing, auditing, and medical-legal purposes PicSafe-Medi is “the missing link” in compliant mobile clinical photography.
Precision IT P: 1300 964 404 F: +61 2 8078 0257 E: firstname.lastname@example.org W: www.precisionit.com.au • Cloud Computing Specialists. • Onsite Medical IT Support. • VoIP Telephone Systems and Internet Connectivity. • IT Equipment Procurement. • Experience with all clinical & practice management software packages. • Sydney, Brisbane, Gold Coast and Melbourne. Precision IT is a highly competent and impeccably professional IT support firm with a primary focus on working with GPs and Specialists. Working with our clients, we develop reliable, robust and feature rich IT systems to meet the demands of the modern medical practice today and into the future. Our Precision Cloud service is fast becoming the choice for new and established practices and covers all of the standard guidelines from the RACGP and AGPAL and GPA. Talk with us today about the future of your practice!
Professional Transcription Solutions P: 1300 768 476 E: email@example.com W: www.etranscriptions.com.au Australia’s Most Trusted Teaching Hospital and Private Practice Transcription Provider • Web-based - Dictate and receive reports anywhere • Double-edited with over 99.5% accuracy • Fast turn-around within 24 - 48 hours, as required • All medical and surgical specialities covered in Australia’s largest teaching hospitals • Rapid documentation of recorded HR interviews, Research and Expert Reports • Guaranteed cost savings • Data held securely at a State Government owned data centre • Call our friendly staff anytime for your overflow, backlog or all of your typing or data entry requirements • Call us now for a no obligation free trial
Shexie Medical System P: 1300 743 943 F: 1300 792 943 E: firstname.lastname@example.org W: www.shexie.com.au Shexie is an Australian owned business which has been developing software for medical practices for over 15 years. Our industry and technical knowledge allows us to provide the ultimate ‘easy to use’, ‘fully functioned’ and ‘robust’ product on the market. Shexie Medical System clinical and practice management software is ideal for surgical or specialist practices of any size. Many fully integrated features including Paperless Office, SMS, full Paperless Electronic Claiming including Eclipse, MIMS Integrated, statistical analysis, security, synchronize appointments with Outlook/PDAs, transcription interface, diagnostic equipment interface, automated MBS/Fund rates updates. Soon to be released Shexie Platinum version also contains eHealth - Health Identifiers, PCEHR and Secure Messaging.
Sysmex P: +61 3 9013 4445 E: email@example.com W: www.sysmex.com.au Sysmex is dedicated solely to helping your healthcare organisation achieve more in less time, with fewer errors and better patient outcomes. Sysmex leads the way in eDiagnostics: • Providing an essential building block for the electronic medical record with the Eclair Clinical Information System • Enabling sharing of key patient information across regions through the Eclair Clinical Data Repository • Completing the electronic loop with laboratory and radiology order request management (CPOE) • Streamlining all areas of the anatomical pathology laboratory workflow from request to report with Delphic AP • Improving reporting times and reducing costs through an enterprise Delphic LIS, shared across multiple laboratories
Totalcare Stat Health Systems (Aust) P: +61 7 3121 6550 F: +61 7 3398 5064 E: firstname.lastname@example.org W: www.stathealth.com.au Stat Health Systems (Aust) has built a progressive and resilient system that introduces a new level of stability and flexibility to the medical software market. Stat is an integrated clinical and practice management application which has embraced the latest Microsoft technology to build a new generation solution. Fully scalable and the only medical software application to incorporate a multi-functional intuitive interface, Stat is at the forefront of computing technology. Stat incorporates all eHealth requirements as per the NEHTA specification. Stat Health provide a premium support service, clinical data conversion from existing software and tailor made installation and training plans for your practice. Facebook: facebook.com/StatHealth Twitter: @NotifyStat
P: +61 7 3252 2425 F: +61 7 3252 2410 E: email@example.com W: www.totalcare.net.au Totalcare is a fully integrated Clinical, Office and Management software suite designed to suit the particular needs and processes of healthcare providers. Used since 1995 by health care facilities across Australia including General and Specialist practice, Radiology, Day Surgery and Hospitals, Totalcare is stable, scalable, customisable and easy to learn and use. From a small practice to a multisite, multi-disciplinary corporate entity or hospital, Totalcare can provide solutions for your needs. • • • • • • • •
Admissions / Appointments Billing Statutory Reporting Integrated SMS Prescriptions Orders & Reports Clinical Notes Letter/Report Writing, Document and Image Management • Scanning and Barcode recognition • Video and Image Capture • HL7 Interfaces
Therapeutic Guidelines Ltd P: 1800 061 260 E: firstname.lastname@example.org W: www.tg.org.au Therapeutic Guidelines Limited is an independent not-for-profit organisation dedicated to deriving guidelines for therapy from the latest world literature, interpreted and distilled by Australia’s most eminent and respected experts. These experts, with many years of clinical experience, work with skilled medical editors to sift and sort through research data, systematic reviews, local protocols and other sources of information, to ensure that the clear and practical recommendations developed are based on the best available evidence.
VIRTUAL CONSULTING ROOMS
VConsult P: 1300 82 66 78 F: 1300 66 10 66 E: email@example.com W: www.vconsult.com.au VConsult offers outsourced practice management solutions for medical and allied health practitioners allowing the focus to be on your professional practice and patient care. VConsult provides a seamless “behind the scenes” service by professionally managing your telephone calls, reception, invoicing and medical transcription requirements.
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 July 2013 release of eTG complete includes updates of further Psychotropic topics. The online version of eTG complete is now optimised for use on smart phones and tablet devices. 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: firstname.lastname@example.org W: www.zedmed.com.au Zedmed is an innovative provider of business solutions to the medical and financial services industries. Our practice and clinical management solution is designed to be simple, intuitive and seamlessly integrated. With personalised training, installation and data conversions from almost all software packages, changing software has never been so easy. Zedmed would also like to introduce to you Medical Record Exchange – a free, simple solution allowing Doctors to send patient’s medical information to insurance companies electronically. Using the latest in data extraction technology and fully encrypted, this is a secure, time-saving solution to one of the most dreaded requests Doctors receive on an almost daily basis. For more information about Medical Record Exchange, please contact us: Phone: 1300 933 833 www.medicalrecordexchange.com.au
Dealing with Difficult Patients 15 Oct Clinical Governance
Sterilisation - Part 1
Sterilisation - Part 2