MediSecure to launch real-time prescription monitoring

Electronic prescription exchange service MediSecure is currently trialling new software that could provide a simple and inexpensive way to introduce a real-time prescription monitoring (RTPM) system to crack down on prescription or doctor shopping.

Called Dr Shop, the software uses the existing capabilities of the MediSecure prescription exchange and will allow information on specific drug molecules prescribed to a patient in the last 90 days to be relayed back to GPs in real time at the point of care.

The development of the system has been driven in part by yet another recommendation from a Victorian coroner for the introduction of real-time prescription monitoring following the accidental death of a patient from a combination of prescription drugs, as well as the slow pace of the roll-out of the proposed national Electronic Reporting and Recording of Controlled Drugs (ERRCD) system.

ERRCD was developed in Tasmania based on its DORA technology and a licence for it was purchased by the federal government on behalf of the states in 2012. However, as reported by Pulse+IT, NSW, Queensland and Western Australia are still laying the groundwork for its potential implementation, while in Victoria a business case has been presented to government but no decision has been made.

Victoria’s former Coalition government did promise funds for the system as part of its election platform, but this promise was not matched by Labor.

In the meantime, the Victorian Coroners Court has held another inquiry into the death of a patient from a combination of prescription drugs. This patient had a previous heroin addiction and a history of schizophrenia, anxiety, depression and chronic pain. The coroner found she died from the combined effects of tramadol, methadone, diazepam, codeine, alprazolam, risperidone, doxepin and metoclopramide.

A search of her PBS records showed she was repeatedly prescribed the same analgesic, anti-anxiety and antidepressant medications from seven different GPs. One GP had treated her for anxiety and depression but was unaware she was also on methadone, which the patient obtained from another GP.

At the inquest into her death, the chief officer for drugs and poisons regulation at the Victorian Department of Health, Matthew McCrone, told the coroner that the implementation of a RTPM system like ERRCD or DORA was complex and likely to be costly. He also said that while most Tasmanian community pharmacists had access to DORA, less than 50 per cent of GPs could use it, and that pharmacists had proven to be reluctant to take on the gatekeeper role.

The coroner also heard evidence from MediSecure CEO Phillip Shepherd and the general manager of competitor system eRx, David Freemantle, that it was technically possible to instead use existing technology to highlight previous prescriptions of not just Schedule 8 drugs, which ERRCD is limited to, but Schedule 4 drugs as well.

Of the drugs the patient in this case was taking, only methadone was Schedule 8 (alprazolam was later rescheduled) and the others were all Schedule 4.

Mr Shepherd told the coroner that the actual cost of adapting existing technology like MediSecure would be minimal, with the main cost related to training and developing protocols for GPs on how to deal with potential doctor shoppers at the point of care.

MediSecure is now set to introduce such a system for its GP users, with a trial currently underway to integrate it with the Best Practice clinical and practice management software, according to MediSecure’s chief of strategy and marketing, Vladimir Finn.

Mr Finn said Dr Shop used the MediSecure electronic prescription exchange, which captures details of the prescription and sends it to a central repository where it can then be downloaded by the pharmacist when the patient presents with the barcoded paper script.

“That information is highly protected and encrypted, as you would imagine, but what we can do is track a very narrow segment of the data, which can provide real-time monitoring of certain elements,” Mr Finn said.

“These elements are the molecules of addiction in dangerous drugs. For those what we can do is provide in real time back to the GP, when they are prescribing medications with those molecules, the last 90 days of prescriptions containing those molecules.”

Unlike ERRCD or DORA, MediSecure can pinpoint Schedule 4 drugs that may have been recently prescribed. It will not tell the GP who has prescribed them, but provide a warning that there may be a contraindication or that the patient is potentially shopping around. This capability will also protect patient privacy, he said.

“Our system gives it back in real time without breaking any user privileges. You can’t track all of the prescriptions of an individual and you can’t do a search on it. It is only in the time when the clinician is prescribing for this very narrow subset of the molecules that we can provide back what that individual has had in the last 90 days. That will allow the clinician to say that you might have a problem and we can help you with that.”

As the coroner heard, one of the main problems that the states are finding in implementing ERRCD is the question of patient privacy. MediSecure believes it can overcome this problem by informing all patients that the practice is monitoring prescriptions at the point of care.

“The patient knows that this GP is using a real-time tool to make sure that they are not prescribing certain medications that are dangerous,” Mr Finn said. “That way everyone is covered with consent and everyone knows where they stand.

“It’s very important to protect privacy and we’ve gone through a lot of legal advice. We’ve consulted with the RACGP in a lot of detail and we also presented this program to the AMA in Western Australia as well as the Department of Health in WA as a solution.”

At the moment, the system will only be available to general practitioners using MediSecure. Mr Finn believes it is more likely that GPs will take it up rather than pharmacists as the real-time monitoring element happens at the point of prescribing, not dispensing.

This is also a failing of the ERRCD system, as it requires the pharmacist to interrupt their workflow and do a search, he said.

Mr Finn said MediSecure had decided to introduce the software now rather than wait for funding from governments, and would provide it free to GPs.

While the long-standing rivalry between MediSecure and eRx is no secret to the industry, Mr Finn said he hoped that eRx would also adopt the technology, which should be relatively easy as both systems are interoperable.

“In the meantime we need to start with something, something that doesn’t cost the taxpayer a truckload of cash,” he said.

MediSecure is trialling it first with Best Practice and then some of the smaller vendors. The company has also been in early talks with the market leader, MedicalDirector, Mr Finn said.

He said the system had received overwhelming support when it was recently demonstrated at the Australian Association of Practice Managers (AAPM) conference, and would hopefully be available early in the new year.

IT capability a concern as aged care comes to grips with CDC

The relative lack of IT capability in the community aged care sector is causing concern as the first moves are made towards a full consumer-directed care (CDC) model, with some providers still looking for solutions to how they will manage the new reporting requirements.

From July 1 next year, all Home Care Packages – which provide personal, support and clinical care to older Australians in their homes – will be delivered on a CDC basis, giving recipients and their families choice and control over the types of care and services they receive and from whom.

These packages include services such as those provided under the former Community Aged Care Packages, which are designed to keep people at home for longer and out of residential aged care, as well as higher level support that was formerly provided under the Extended Aged Care at Home and Extended Aged Care at Home Dementia packages.

They can include basic support with household chores or personal hygiene, as well as more intensive support from district nurses and other health needs such as physiotherapy, nutrition assessments and hearing and vision services.

Under the new model, all recipients of a Home Support Package will receive a personalised budget showing how much government funding is available and how it is being spent. A Department of Social Services (DSS) spokesperson said the consumer must be provided with a monthly statement of income and expenditure, including the balance of funds.

That all sounds good in theory and most in the industry support CDC, but in practice it is causing a few concerns, not the least for the IT back-up that community aged care providers will need.

As industry consultant and former CEO of Aged Care Association Australia (ACAA) Rod Young puts it, a monthly statement for a handful of package recipients is doable in Excel, but when those numbers rise, so do the headaches.

“In the consumer-directed care environment, all package care recipients are to receive a monthly report on their services and their dollar balance,” Mr Young said.

“If you’ve got 30 clients you can probably manage that on a spreadsheet. If you’ve got 130 clients it becomes really difficult and if you’ve got 1300 clients it becomes impossible. The need for IT enablement in the industry becomes quite crucial.”

Community aged care is supported by a number of well-regarded software packages, some designed specifically for particular populations such as The Care Manager, some provided by residential aged care vendors such as iCareHealth and others developed in-house by larger providers such as Silver Chain subsidiary EOS Technologies.

However, for smaller providers, the looming CDC requirements are proving a bit of a nightmare, not the least because many still function on paper.

“When you get to applying it across the whole package in the community from July next year, and then you’ve got providers with hundreds and in a lot of cases thousands of clients, and when you get to hundreds of thousands of clients, you can do it by paper but it would take a small army to do that,” Mr Young said.

Patrick Reid, CEO of Leading Age Services Australia (LASA), said the provision of services and the budgeting requirements under CDC were about to become a lot more complex.
“CDC in terms of the menu of services people provide and how people avail themselves of the opportunity to select their services, I think it’s going to be interesting,” Mr Reid said.

“The other issue is what happens in the true CDC model where people may pick more than one provider. In the past it has been sort of a job lot – you have services provided by somebody, but in this new world you could potentially have two, three, four, five different providers providing different things.

“Will consumers be aware that they are getting five or six or seven different reconciliations if they’re choosing more than one provider for different service? Some of these things will come out over time – there is an assumption that the majority of these services will be provided by one provider – and what we are concerned about is that you will have the reconciliation process, but you will also then potentially have an arbitrage between different providers to have one provider as the point man for reconciliation.”

Mr Reid said the larger providers like RDNS, Silver Chain and Kincare are working hard on their IT capability and developing the infrastructure required, but others are finding it a bit more difficult.

“They are still struggling a little bit with what they need to do and how they are going to do it, because there is very little guidance and it is early days,” he said. “There is still a lot of grey out in the market place around this.”

The DSS spokesperson said that in addition to monthly reports, all information must be provided in a format that is simple for older Australians and their families to understand.

“Where required, the provider must arrange for the individualised budget and/or regular statements to be made available in a language other than English,” the spokesperson said.

DSS is not prescribing a template for these reports, and the reports will not be transmitted to the client online through the Aged Care Gateway.

“How a report is transmitted, and in what reporting format, is determined by consultation between the provider and the client as part of the Home Care Agreement and care planning process,” the spokesperson said.

Mr Young said the industry had known they have to do this for some time, but there are a lot scratching their heads over how they are going to manage it. It is also probable that CDC will be introduced to recipients of the Home and Community Care (HACC) packages, which are joint state and federally funded packages that provide low-level services in the home or through community care centres.

“There are a couple of IT vendors who can provide some of the solutions, but I think some people are going to get caught short or find it is going to be more difficult than they anticipated,” he said.

“It’s an issue that most providers are now aware of in at least the package environment, and if the government does decide to extend it to HACC in the future, then they will have to take some time as they simply couldn’t do it in the matter of a year. It would be impossible for the whole industry to become enabled.”

Mr Reid agreed. “There is still a way to go,” he said. “What we do have is the vendors who are manfully trying to deal with these things, but again, it seems a niche part of the IT world.

“From my point of view, for the good of older Australians, the government and the industry itself needs to have a good hard look about what they require and how they going to fund the infrastructure required to make it work as best as possible.”

Health Minister Jonathan Coleman to address HiNZ conference

New Zealand’s new minister for health, Jonathan Coleman, will speak at the Health Informatics New Zealand (HiNZ) conference in Auckland next week.

Dr Coleman, who has a medical degree and worked as a general practitioner for some time but is no longer registered, will provide a short presentation on Tuesday, November 11, necessitating a slight rearrangement of the afternoon schedule.

HiNZ CEO Kim Mundell said registrations for this year’s conference had almost reached 500, a huge increase on the 350 who attended last year’s conference.

HiNZ has undergone a restructure this year with the appointment of a full-time CEO in Ms Mundell in April. It is also looking to make some changes to its constitution to move it from a volunteer organisation into a more professional body.

Ten people from the sector have put up their hands for five roles on the HiNZ board, voting for which opens on Friday, November 7. The new board will be announced at the HiNZ annual general meeting on Wednesday, November 12.

Patient portals have been high on the NZ health IT agenda for some time, so the theme of the HiNZ great debate this year has been chosen to reflect the interest. The tongue-in-cheek theme of the debate is ‘Will patient portals make us all hypochondriacs?’

Two teams will compete to win the debate. The case for the affirmative will be presented by Kate Baddock, chair of the NZMA GP Council, with assistance from David Russell, former CEO of the Consumers Institute, and comedian Michele A’Court.

Arguing the case for the negative will be National Health IT Board eHealth ambassador and general practitioner Andrew Miller, consumer advocate Jo Fitzpatrick and comedian Jeremy Elwood.

Audience participation via the online conference app will decide the winning team.

HINZ 2014 will kick off with five workshops on Monday, November 10, covering telehealth, usability, IT and health management, mobile access to health information, and sharing personal health information.

NHITB director Graeme Osborne will be joined by Dr Miller and Carolyn Gullery, general manager of planning, funding and decision support at the Canterbury and West Coast DHBs, to provide the keynote presentations on the opening day.

International speakers include leading eHealth safety and implementation experts Enrico Coiera of the University of NSW in Australia and Trisha Greenhalgh of Barts and the London School of Medicine, who will present via video conference.

The HiNZ Conference is being held at Skycity Auckland from November 10 to 12. For more information, see www.hinz.org.nz.

Health Informatics New Zealand: where to from here?

This story first appeared in the October 2014 issue of Pulse+IT Magazine.

Health informatics underpins a nation’s ability to deliver an affordable, flexible health system that will provide better health outcomes to its citizens, but how do you create a health informatics expert? Do you teach a clinical person about IT, or do you teach an IT person about healthcare? The short answer is we need to do both.

Health Informatics New Zealand (HiNZ) is a non-profit organisation founded 14 years ago from the amalgamation of two special interest groups: nursing informatics and medical informatics. A group of energetic volunteers then established an annual conference to provide a platform to leverage local and international best practice, and support the development of the health informatics field in New Zealand.

Since then the New Zealand health sector has changed dramatically. Topics such as predictive analytics, self-management and the patient portal are more broadly developed yet they continue to change and influence health policy. There has been a significant shift in the way health IT projects are funded, controlled and delivered with the establishment of the National Health IT Board and its subsequent release of the National Health IT Plan in 2010.

“HiNZ is in a transition phase,” HINZ chair Liz Schoff says. “To deliver better value to our members we have moved from an all-volunteer structure focused on an annual event, to a more strategic model with a full time chief executive. Our goal is to deliver additional services, ongoing communities of practice and collaboration with other health organisations in New Zealand.”

Health informatics underpins a nation’s ability to deliver an affordable, flexible health system that will provide better health outcomes to its citizens.

Health informatics is the field that deals with the storage, retrieval, sharing and optimal use of health information, data and knowledge for problem solving and decision making. It covers a broad range of activities including electronic health records, knowledge management, decision support, telemedicine and telehealth, standards, evidence for benefit/harm, ethics and security.

But it is about far more than technology. Increasingly, the focus within the health informatics field is on communication and change management. Without effective communication, technology projects are unlikely to be successful.

Delivering on these large-scale health sector projects requires the use of multi-disciplinary teams. To deliver workable solutions we need the combined expertise of clinical experts and technology experts.

So how do you create a health informatics expert? Do you teach a clinical person about IT? Or do you teach an IT person about healthcare? The short answer is we need to do both. If we are to be successful in designing effective solutions to transform the health sector, New Zealand needs clinicians who know about IT and technology experts who know about health. In other words, we need many more health informatics practitioners, now and in coming decades.

The purpose of HiNZ

HiNZ has five key reasons for being:

The funding for HiNZ comes from membership fees, event registration fees, trade exhibitions, vendor sponsorship and government grants. We have no majority funder from any institution, organisation or government source, which allows us to be an independent entity.

Membership of HiNZ is for anyone with an interest in health informatics. As a consequence, compared to other professional organisations, ours has an unusually diverse membership base.

Members include clinicians, health sector managers, government personnel, vendors, academics, IT professionals and other NGOs. HiNZ builds and strengthens connections between these groups.

The key differentiator of HiNZ is its neutrality. Our most important function is to provide a safe, neutral environment, within which collaboration can sprout and grow.
The health IT sector encompasses a wide range of stakeholders, from non-profits to commercial entities; from organisations with 10,000 employees to one-man consultancy practices.

HiNZ is not a lobby group for any one group, we have no political affiliations, and we do not choose favourites. HiNZ aims to provide a level playing field and encourages the sharing of ideas across the sector.

Many HiNZ members are in competition with each other. Some are competing for a slice of government funding or for research grants. Others are competing to win commercial contracts. Some compete within an organisation for a share of its limited operational budget.

It can be difficult in such a competitive environment for important conversations to take place, but they need to take place if the field of health informatics is to reach its full potential and enable the delivery of effective health solutions to all New Zealanders. HiNZ helps give everyone a voice around the table.

Changes underway

For 13 years HiNZ has run a conference that brings together the movers and shakers in health informatics. The conference has been the foundation activity of HiNZ, and this will continue, but to be effective HiNZ needs to do much more than this.

Since my appointment as chief executive, I have spent a lot of time listening to members: researching what they want, how they want it delivered, and where and when they want it. It is already clear we need to deliver information and support to our members in more diverse ways.

Based on international trends, we also need to be ready to support further changes in communication technologies, portability, genomics and telehealth in addition to managing changing public expectations and the digital divide.

Importantly, we need to broaden our reach beyond the current HiNZ membership. The health sector has changed and there is a broader awareness of the need for integrated health teams that include all players in the health sector: information specialists, clinical specialists, administrative staff, policy makers and patients. HINZ is reaching out to those who have not been able to easily leverage the value of health informatics.

Historically, HiNZ has primarily engaged with people who are knowledgeable about both technology and the health sector, and who might identify themselves as a health informatician. For health informatics to deliver on its full potential, HiNZ needs to engage with a much wider group.

We need to more directly target health sector experts who have minimal knowledge of technology, and technology experts who have limited knowledge of the health sector. For technology solutions to be successful, the clinician’s point of view must be taken into account, and end users need to understand more about technology. This wider group includes decision makers who will have a large influence on the future of the New Zealand health care sector.

HiNZ is now focused on this broader constituency when planning and assessing future activities.

Looking ahead to 2015

To engage with clinicians we are taking health informatics to them, rather than expecting them to seek us out. Last year HiNZ launched the popular Primer Series, free workshops held in hospitals for clinicians who wished to learn more health informatics. HiNZ has been invited to deliver a health informatics stream within the 2015 Lab Meeting for senior laboratory staff and pathologists. We welcome invitations from other professional groups who would like their members to learn more about health informatics.

In 2015 HiNZ will support a wider range of seminars and events, starting with a hackathon on self-care health solutions at the University of Auckland in February 2015.

The Certified Health Informatics Australasia (CHIA) qualification was recently launched by the Health Informatics Society of Australia (HISA) and the Australasian College of Health Informatics (ACHI). We are in discussions with these organisations to bring a local version of the CHIA certification to New Zealand.

As a visible symbol of our transition, we have updated the HiNZ logo to reflect our role as a member based organisation that brings together a diverse group of people to collaborate.

We are currently focused on preparing an exceptional 2014 conference. The HiNZ Conference, “Making IT work for you today: Routes to transformational change”, is being held at Sky City in the Auckland CBD from November 10 to 12.

Here are five reasons why you should attend the 2014 HiNZ Conference:

For more information go to www.hinz.org.nz

About the author

Kim Mundell was appointed chief executive of HiNZ in April 2014. Kim was previously CEO for a government-funded disability service provider and owner of Healthy Food Guide magazine. Through her consulting business, Kim provides business advice to non-profit organisations. She originally trained as a registered nurse.

Opinion: the future of health is mobile

This story first appeared in the November 2014 issue of Pulse+IT Magazine.

Everyone these days seems to have a mobile phone, and most these days are smartphones, providing consumers with a portable computer wherever they go. This high penetration of smartphones means they can be harnessed for public health interventions, and evidence is increasingly showing that mobile-based healthcare works.

Never has there been a technology with such rapid uptake globally as that seen with the spread of mobile phones. In New Zealand, we have had more mobile phone subscriptions than people since around 2008. While that may not mean every single person has a mobile phone, there is certainly very high penetration. And there is some evidence of a lack of a digital divide – that is, access to mobile phones is not affected by socio-economic status, unlike access to the internet.

The majority of New Zealanders with a mobile phone keep it close at hand 24 hours a day. The proportion of phones that are smartphones with a computer operating system is rapidly increasing, with up to 60 per cent of all mobile phones in 2013. This means that at any time of day, regardless of location, most people have a personal, portable, connected computer on them. This also means that they have unprecedented access to health information and close to 100,000 health and wellness apps.

What does all of this mean for health services? It could mean the rise of the well-informed and engaged patient. Particularly in the context of the ‘quantified self’ movement and the rapid increase in mobile and wearable sensors, people are becoming more aware of their body’s responses to lifestyle changes and medications.

This could lead to several changes in the way care is provided, with patients coming to the consultation as the experts in themselves and the clinician bringing their expertise and experience to co-develop a care plan. Potentially, far greater amounts of data will be available to inform care. Where data are currently available for particular time points, mobile and wearable sensors bring the ability to fill in the gaps with continuous monitoring data. This will entail a greater reliance on smarter health IT systems and algorithms capable of interpreting that data so that we know when to act on it.

At this point in time, this may look like a system only for the engaged and motivated. However, systems are being developed that will passively collect data via the smartphone, with no motivation or action required. This leads to the concept of a health coach in the pocket, quietly collecting and analysing data in order to intervene with programs to support healthy behaviour change and self-management of long-term conditions.

If this all sounds a step too far into an idealised future, let’s consider some of the current impacts of mobile on health services. Clinicians of all types are currently being asked to recommend apps to help support a myriad of conditions. How do they know which ones are evidence-based or adhere to treatment guidelines? How would they assess whether they are at all useful for their patients?

The idea of a New Zealand ‘App Formulary’ with evaluations of apps for various medical conditions that can be prescribed by clinicians for their patients is being discussed in many fora. The current lack of a decent evidence base in smartphone health apps should render this task quite do-able in the short term.

New Zealand has led the way internationally in evidence-based text messaging mHealth programs. We were the first to develop and publish a randomised controlled trial on a health intervention delivered solely by text messages, and have gone on to confirm the effectiveness of text messaging for smoking cessation programs in Cochrane systematic reviews.

At the National Institute for Health Innovation, we have been working with Waitemata and Auckland District Health Boards (DHBs) on two new text message programs. These include TextMATCH, a text message health information program for pregnant women and their families, and for the families of young children. This program supports a broader Healthy Babies, Healthy Futures initiative to prevent the onset of childhood obesity. It has been designed with different versions for Maori, Pacific, Asian and South Asian families and is currently being evaluated for its impact on attitudes and behaviours.

SMS4BG is a two-way text message program to support people with diabetes to self-manage between clinic visits. A pilot study across Waitemata DHB showed that it was appreciated by participants, supported them to manage their condition better, and improved diabetes control (measured by change in HbA1c level) in 81 per cent of participants with data available. We have recently been awarded funding for a large trial of its effectiveness.

Many other good local mHealth examples exist including apps like FoodSwitch, Listen Please and Tapuaki (look them up on iTunes or the Google Play store). Health and wellness are happening around us, supported by mobile technologies, all the time. There can be little doubt that the future of health is mobile.

About the author

Dr Robyn Whittaker is a program leader in health informatics technology at the National Institute for Health Information, University of Auckland, and a public health physician with the Waitemata District Health Board. Her research concentrates on the use of mobile health technology for population health interventions, as well as clinical trials and epidemiology.

Three finalists announced for Clinicians’ Challenge

Ideas for a smartphone app to give advice to people with chronic kidney disease, an emergency department at a glance information system and a tool to electronically record information on clinical consultations about sick kids make up the three finalists in this year’s Clinicians’ Challenge.

The annual challenge, organised by Health Informatics New Zealand (HiNZ) in association with the National Health IT Board (NHITB), offers a prize of $10,000 to the winning clinician and $5000 to the runners-up.

It aims to encourage clinicians to identify ways technology can improve their clinical practice and improve patient outcomes.

The three finalists are Allister Williams, a consultant physician and nephrologist from Taranaki DHB. Dr Williams proposed MyKidneys, a web-based smartphone app to give people with chronic kidney disease the advice and support they need to participate in their own care.

Tom Morton, an emergency physician at Nelson Marlborough DHB, suggested Emergency Department at a Glance, an information system that displays data for managing patients’ journey through an emergency department.

John Garrett, a paediatrician from Canterbury DHB and West Coast DHB, proposed a tool to electronically record information on clinical consultations about sick children or newborn babies.

All three finalists have been invited to present their proposals to judges at the HiNZ conference in Auckland next week, with the winner announced November 11.

The grants are intended to be used to conduct more research, make a site visit, attend a related conference or carry out further work on the proposals.

NHITB director Graeme Osborne said proposals can range from consumer mobile apps to clinical decision support tools or systems that made better use of the rich information sources available.”

“Clinicians exceeded our expectations with the breadth of their proposals for improving the consumer experience, making healthcare more efficient or supporting a better integrated healthcare model,” Mr Osborne said.

“In addition to the three finalists’ proposals, there were many more great ideas that I hope clinicians will continue to develop further to extend the use of information systems in health.”

Medtech gears up for version 20.12 as Evolution gathers steam

New Zealand’s market leading general practice clinical and practice management software vendor Medtech is getting ready for the release of version 20.12 of Medtech32 this month as its ultimate replacement, Evolution, begins to gain traction.

MT32 v20.12 will feature a number of enhancements such as changes to the display of elements like cross reactivity interaction warnings for medications and the result imported dates in the provider and patient inboxes. A new nurse practitioners ACC class has also been added.

SMS-related enhancements include the option to resend an SMS from the SMS outbox, the ability to resend SMSs that have expired, and better management of SMSs by displaying the credits left.

There will also be enhancements to ManageMyHealth-related functionalities in MT32, including the display of multiple medication request from ManageMyHealth in one single medication record and the ability to forward emails within the ManageMyHealth Medtech32 provider inbox.

While MT32 will continue to be supported for the foreseeable future, Medtech is planning to slowly migrate users over to Evolution, a completely redesigned system that still includes much of MT32’s functions and shortcuts but with a new Microsoft Office-like interface.

Medtech says the transition plan to Evolution does not contemplate the discontinuation of Medtech32 for at least five years.

Evolution has recently been implemented for over 60 users at Nirvana Health Group in East Tamaki and West Auckland.

Medtech executive chairman Vino Ramayah said the number of users will increase gradually to more than 400 as Evolution replaces Medtech32 at Nirvana Group.

Nirvana Group chairman Kanti Patel said Evolution had significant flexibility over MT32 or any other software the organisation reviewed.

“The technology is highly secure and also interoperates with other products and works with other third-party products such as Medtech32 did,” Dr Patel said.

The Nirvana Group also plans to adopt the ManageMyHealth portal and patient communication technology early next year.

Orion Health sets the price for its IPO

Orion Health is set to launch its long-awaited initial public offer (IPO) and list on the New Zealand and Australian stock exchanges at the end of November.

Orion Health is looking to raise between $NZ120 and $150 million in the offer, with the intention of boosting its research and development capabilities. It says it expects to form around 40 new R&D teams over the next two years, equivalent to over 300 people.

In its financial statement announcing the IPO, Orion Health said it was currently a loss-making business and does not expect to be profitable in the short term. It has operating revenue of $153m for the 2014 financial year.

It expects to offer over between 20 and 30 million shares at $4.30 to $5.70 a share. This would value it by market capitalisation at between $720 million and $915 million.

Orion says it plans to use the proceeds to continue to increase its R&D capacity with an emphasis on its Healthier Populations solution group. The company recently outlined its strategy to some of its user groups in Australia, announcing it had split the business into three solution groups called Intelligent Integration, Healthier Populations and Smarter Hospitals.

Intelligent Integration covers its existing health information exchange (HIE) business, which currently brings in much of its revenue in the US market.

Smarter Hospitals is the business segment it is most active in in New Zealand and Australia. The company describes Healthier Populations as the provision of care coordination, analytics and engagement tools for managing the healthcare needs beyond the walls of hospitals and into the community.

This is where it sees much of its future growth occurring, particularly in the US market. It recently signed agreements with two US insurers – Highmark, which is the ninth largest fund, and Blue Shield California, the 15th largest.

It plans to create new functionalities for these customers and create value through preventative strategies to keep people at home and healthy.

It lists its main competitors in the Healthier Populations segment in the US as InterSystems, Optum, AthenaHealth, Explorys, Medicity, Lumeris and DB Motion. Both Optum and Medicity are owned by insurers.

At the user group day, Orion Health founder and CEO Ian McCrae said he intended to expand the Smarter Hospitals segment and take on the big guys, including Epic, Cerner, CSC and InterSystems, along with local vendors.

Integrated operations centre goes live at Capital & Coast

Capital & Coast District Health Board has opened its integrated operations centre (IOC) for Kenepuru and Wellington hospitals to manage activity and coordinate responses.

Over the next nine months, the TrendCare patient acuity, workforce planning and workload management system will be rolled out, along with electronic whiteboards at the ward level to assist clinical decision making.

The idea is to enable key teams to use real-time information for clinical and operational decision making across the organisation.

Capital & Coast DHB interim chief executive Debbie Chin said the IOC was “a ‘whole of hospital’ commitment to better patient outcomes and safe staffing levels.

“We know that collaboration is key when it comes to ensuring shorter, safer journeys for hospital patients and an environment like this brings the whole organisation together to achieve that,” Ms Chin said.

“At a practical level this means utilising high tech screens, which display information to provide a better understanding of bed occupancy, patient care needs and staffing requirements.”

Hutt Valley DHB is also using electronic whiteboards to good effect, she said.

The 3DHBs – Capital & Coast, Hutt Valley and Wairarapa – are also nearing a decision on the implementation of an integrated laboratory service that will see laboratory services across the three DHBs operate as one integrated system for both the community and hospital sectors.

A request for proposal has gone out for the new service, one requirement of which is the ability for referrers to access any patient’s test result regardless of where they are in the healthcare system, preferably through the development of a single data repository for the 3DHBs.

Self check-in kiosk for Thames Hospital ED

Thames Hospital is running a pilot involving a self check-in kiosk in its emergency department to see if it can speed up triage.

The kiosk has been adapted by New Zealand firm Health Kiosk from its current kiosk technology, which can provide fast and accurate health measurements.

The kiosk will be offered to patients who present at the front desk to self-register and have their height, weight, BMI, blood pressure, pulse and oxygen saturation measured electronically.

The pilot program was inspired by Thames Hospital’s clinical director Ruth Large, who was a finalist in last year’s HiNZ Clinicians’ Challenge.

Dr Large said nursing and reception staff will collect the information from the kiosk to allow for more private collection of patient details and to speed up the triage process.

“In most emergency departments in the country, patients give their details first to a receptionist and then to a triage nurse,” she said.

“It is very difficult to ensure privacy of information in this process and it is also time consuming for both the patient and the triage team.

“My hope is that we can demonstrate a speeding up of our triage practice as well as finding out if use of this technology is acceptable to the patients and the staff.”

The technology is being trialled in conjunction with the National Institute for Health Innovation and in addition to speeding up triage, it aims to explore the acceptability of the technology in a real New Zealand emergency department setting. It will collect both patient and provider perspectives.

The trial of the kiosk will be voluntary and only involve patients who come to the front desk of the hospital and not those who arrive by ambulance.