Holiday reading: Telehealth

Pulse+IT is taking a break from daily news reporting for the festive season but will return on Monday, January 5.

If you are after some holiday reading, you may like to review our 2014 Telehealth magazine online below. This and other editions of Pulse+IT are available via the ‘Magazines’ menu at the top of this site, and also via the Issuu app for iOS and Android devices.

Holiday reading: National eHealth Agenda

Pulse+IT is taking a break from daily news reporting for the festive season but will return on Monday, January 5.

If you are after some holiday reading, you may like to review our 2014 National eHealth Agenda magazine online below. This and other editions of Pulse+IT are available via the ‘Magazines’ menu at the top of this site, and also via the Issuu app for iOS and Android devices.

Drag-and-drop data visualisation for big data discovery

Data visualisation specialist Qlik has released a new, self-service version of its software that it says will allow any information worker to do data analytics and business intelligence (BI) more easily and on any device.

Originally a Swedish firm, Qlik has been a market leader in data visualisation for BI for a number of years through its QlikView product, which the company says is used by 33,000 customers around the world. This includes the UK National Health Service’s National Institute for Health Research (NIHR), which uses it for big data analytics for its Clinical Research Network.

Local users include the Peter MacCallum Cancer Centre, Royal Victorian Ear and Eye Hospital, St Vincent’s Hospital Sydney, and the Inner East Melbourne Medicare Local.

It has now released Qlik Sense, which uses Qlik’s data indexing engine to allow users to create personalised data analyses and explore the relationships that exist in data to reveal connections instantly.

Users can drag and drop data into a range of different graphs and charts that are interactive and linked to the software on mobile phones, tablets and desktops. Qlik’s lead product manager John Trigg said the product had been designed for mobile first, but that it had the capability to instantly and dynamically adjust itself to device being used.

Launching Qlik Sense in Sydney yesterday as part of a world tour, Qlik’s vice president for global sales Christof Majer said the software had been designed to mimic human intuition and innate pattern recognition capabilities.

It also uses a Google-like search capability to easily find any data point and drag and drop it into a graph or table for further analysis.

Mr Trigg said the idea was about “democratising the BI process” and allowing any person to do data analysis, not just data scientists.

“But it’s not just a pretty desktop tool,” Mr Trigg said. “It has been built to be enterprise class and it has the right level of security so that you can maintain trust in the data.”

It contains a rules engine to allow the IT department to control who has access to what data and where and to whom it can be published.

The company says Qlik Sense supports robust data integration that can combine multiple, disparate data sources and provide seamless analysis across them, including fast calculations, associative exploration and search.

It has been released with a range of application programming interfaces (APIs) to allow developers to embed it into web pages and custom applications. It also allows data integration capabilities that don’t require external tools or data repositories.

“Qlik Sense can connect to and combine virtually any data source, including spreadsheets, databases, operational systems, ERP and web sources. And with Direct Discovery, resident big data sources such as Hadoop, Teradata and Cloudera can be integrated without requiring data to be loaded into memory.”

Mr Trigg said intuitive data visualisation was essential when it came to big data such as that generated by the healthcare sector.

“As you start talking about the notion of big data, we start thinking how, from a user perception perspective, how do we get all of that data in a meaningful way onto a screen,” he said. “We want to make sure that Qlik Sense gives you the most relevant information, but also give you clues to go look for the additional things that give you additional insight.”

Qlik is offering a free desktop version for personal users.

Post-PCEHR development roadmaps for GP software vendors

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

While the government considers the findings of the review into the PCEHR and decides upon its next course of action in relation to the system, GP software vendors are using the opportunity to consolidate the work they have done on the PCEHR, and revisit their other development priorities.

Development work on the PCEHR commenced in earnest with the formation
of the GP vendor panel in 2011. The process, coordinated by the National E-Health Transition Authority (NEHTA), provided funding assistance and support to six clinical software development companies with a view to fast-tracking the rollout of PCEHR-enabled solutions to the general practice market.

In the intervening years, these software developers, as well as several others not engaged in the GP vendor panel process, have built interfaces to not only the PCEHR, but some of its underlying foundations including the Healthcare Identifiers Service (HI Service).

Despite the fact that many of these interfaces have largely been ignored by the clinicians the government intended to use them, the programming and refinement of PCEHR features in GP software has nevertheless consumed considerable development resources.

As one software developer reported to Pulse+IT: “A lot of our resources have been dedicated to the initial release of the PCEHR. Now that that’s all been released, we are working on finalising the minor changes that need to be done, so we are now able to focus on other things that need to be done for our customers.”

To read the full story, click here for the August 2014 issue of Pulse+IT Magazine.

Opinion: How redundancy ensures medical practice continuity

Those in information technology or engineering circles are unlikely to panic when hearing the word ‘redundancy’, as the discussion is unlikely to involve an employment severance package or lay-off.

In technology terms, redundancy means the creation of fail safes that take over when the primary function has failed. This is common practice even at a component level in hardware devices and allows the desired service or device to seamlessly transfer to another back-up system.

Redundant systems are important to every company, regardless of industry, but they are especially important to those that manage critical information such as medical records. In an ideal world, all healthcare providers will consider the importance of such systems and utilise them to ensure uninterrupted medical care, even in the event of a natural disaster or service interruptions such as power outages or lack of broadband connectivity.

How can medical practices and other healthcare providers ensure their practice can weather any storm? Since many companies have on-premise or cloud-based IT solutions, it is important to ensure that the technology provider has put redundant systems in place, especially in the area of data back-ups.

In addition, many cloud providers offer data replication to servers in other geographical locations, as data centres can also experience service failure.

The use of mirroring and other methods at a hard drive level ensure real-time copies of drives are always available, and that data back-ups take place at scheduled intervals.

The same precautions are taken for on-site systems, even if simply using an external hard drive. For those with servers, a network attached storage (NAS) is recommended. Both will ensure that data is backed up if back-ups are placed on another drive.

Selecting a partition on the same drive is a recipe for disaster as the hard drive will inevitably fail. It’s just a matter of when, as some hard drives fail in less than four years.

Mirroring hard drives can ensure business continuity as the failed drive is taken over by its back-up with no interruption in service. The downside is they are difficult to configure for those without technical knowledge. Ensuring data is accessible from multiple workstations is advised as restoring a failed PC can take some time.

With the service provider and hardware taken care of, service interruption is the biggest problem that remains. Luckily, technology can resolve that problem easily.

Power outages can occur and sudden power loss or surges can cause irreparable damage to hard drives, so the best solution is to employ an uninterruptible power supply (UPS) that switches immediately to a battery or back-up generator.

In the case of broadband loss, the solution is even easier: have a back-up broadband connection in place using 3G or other mobile standard. A router that switches between the two will ensure that critical communications between sites or patients remains in place, with most not even noticing the temporary loss of the primary broadband connection.

With a little planning, there is no reason why smaller clinics cannot enjoy the same redundancy features as those enjoyed by global enterprises.

Rob Khamas is an eHealth solutions strategist with REND Tech Associates.

Creative design thinking in bed space for ICUs

The practice of medicine is becoming increasingly reliant on knowledge, expertise and technology from interdisciplinary fields that were traditionally considered alien to the domain.

This is especially so in complex and advanced specialties such as intensive care, where practitioners frequently encounter the need to use multiple devices and equipment to support a critically ill patient.

The number of such devices that populate a typical intensive care bed space is multiplying every year. They range from organ support devices such as ventilators and dialysis machines to monitoring systems to clinical information systems.

The advent and usage of such systems have made it possible for many patients to recover from complex and serious illnesses, which would have not been possible without those systems. They have also made it possible for the physicians to detect deterioration early and address them in a timely fashion.

However, there is an alarming lack of integration among these various bits and pieces of equipment despite their individual sophistication. This leads to a possible lack of efficiency and even potential harm to patients and their caregivers in certain circumstances.

A typical ICU patient is surrounded by at least 12 different pieces of equipment which cause clutter and restrict access to the patient in emergency situations, in addition to being a potential occupational health hazard.

The individually sophisticated systems were designed to fulfil their own roles without much consideration being given for their interaction with the patient, caregivers and other equipment in the patient’s vicinity. For instance, a dialysis machine is not particularly designed to take into account the ventilator tubing which might be in its vicinity in the ICU bed space.

The authors facilitated and supervised an observational study titled “Observation and analysis of ICU designs” that won an international design award for University of Canberra industrial design masters students Hugh Stehlik and Blake Fenwick.

The study observed existing ICU designs and proposed an integrated ‘concept ICU bed space’.

The authors are currently involved in the design and development of the integrated patient care environment (IPCE) for intensive care units in addition to a design-centric approach to developing a novel fluid-monitoring system for use in the ICU.

Integrated patient care environment

The advancement in ICU organ support and monitoring is analogous to the evolution of computing technology. Lessons can be learnt from computing technology, which faced a similar bottleneck in its early years because of individually sophisticated elements being connected in a complex, unreliable and inefficient manner.

Today’s modern, efficient and reliable microcomputers and smartphones would not have been possible if the computing world did not take this problem of lack of integration seriously. The idea that transformed the industry is called very-large-scale integration (VLSI), which is the process of creating an integrated circuit by combining thousands of transistors into a single chip.

It should be acknowledged that although the diminutive scale of microprocessor design and the relative linearity of electronic systems made this feat achievable by reducing redundant circuits and connections, the same degree of integration may not be possible in a large structure like ICU.

Nevertheless, the problem that led to the conception of the design idea has a striking similarity to the problem that the modern ICU faces – lack of integration, redundancy, unreliable connections, inefficient and error prone systems. And the design solution that it points to has a lot of similarities.

An integrated patient care environment (IPCE) as an alternative to an ICU bed space could be developed with our concept in mind. Such IPCEs could help formulate the design rules to develop the equipment and devices around the patient in the short and medium-term future.

This is as opposed to the patient’s bed space being tailored for manufactured devices. Many pieces of equipment with redundant systems (electrical transformers, mount systems, motors, digital signal processors etc.) could be designed to share a common platform. This would potentially lead to much leaner, efficient, space-efficient and cost-effective design of organ support systems.

Energy sources could be integrated into the IPCE design thereby avoiding the plethora of chaotic cables. Such IPCE design would require coming together of a large number of individuals from various domains ranging from bedside specialists to equipment designers.

A ‘design-centric’ approach to product development, whereby an innovative concept is developed from the outset with human factors in mind as opposed to a plain engineering approach, will help achieve such goals. With this in mind, the authors are involved in developing an IPCE for intensive care units which aims to replace the many devices and equipment with one holistically designed unit.

It is imperative that the problem of lack of integration be understood as a significant one, both in the ICU and other specialties. Although objective data regarding the implications of existing unintegrated, non-patient centric designs is lacking, it is obvious that such systems are prone to inefficiency, unreliability and even potential for harm.

Inter-disciplinary domains such as industrial design, user-experience design and engineering have a lot to contribute to the development of a futuristic, integrated and patient-centric ICU design.

Such design could promote innovation and advancement of existing systems while at the same time could improve the efficiency of the ICU bed space. This could potentially be translated to better patient outcomes and improved cost efficiency.

We would appreciate inquiries for collaboration in development and participation in further research into this novel concept from interested individuals or entities.

About the authors

Telehealth in the home: NBN remains the gold standard

Preliminary results from several telehealth trials funded under the $20 million NBN-Enabled Telehealth Pilots Program have shown many positives for monitoring older patients living at home, with project leaders agreeing that the quality and reliability of the National Broadband Network (NBN) was clearly superior to other broadband delivery services.

The NBN-Enabled Telehealth Pilots Program was announced by the Labor government in 2012, with the successful bidders beginning the trials in 2013. It was subsequently renamed the Telehealth Pilots Programme by the Coalition government and opened up to any broadband service, including ADSL/ADSL2+ and 3G/4G wireless.

Early results in three of the pilot projects – Flinders University’s telehealth in the home for rehab, aged and palliative care; the CSIRO’s home monitoring of chronic disease for aged care; and Integrated Living’s enhanced aged care for indigenous Australians – were presented at the Information Technology in Aged Care (ITAC) conference in Hobart last week.

RDNS also presented at the conference on results from its Victorian government-funded Broadband Enabled Innovation Project (BEIP). Its federally funded project under the NBN program, called the Integrated Home Telehealth project, is still in its implementation stage.

Project leaders agreed that the NBN was the gold standard, not necessarily just for its speed but for its reliability, with the Flinders University project – which did have some NBN-connected clients but predominantly used 3G and other low-cost technologies – experiencing some traffic snarls when the 3G spectrum was busy.

However, all agreed that while the technology was important, the challenges of telehealth remain the development of sustainable funding models and clinical change management.

Branko Celler, principal scientist at CSIRO Computational Informatics and a pioneer of telehealth provision in Australia, discussed some early findings of one of the two CSIRO projects funded under the program. The home monitoring of chronic disease for aged care project is a multi-site, multi-state project that also involves several Medicare Locals, telehealth device supplier TeleMedCare, internet service provider iiNet and tablet manufacturer Samsung.

Older people living at home were provided with a free internet connection and a TeleMedCare device, which allows for video conferencing and vital signs monitoring through peripherals including blood pressure monitors, pulse oximeters and ECGs.

Professor Celler said patient selection for the trial was based on a minimal model. “We selected any patient who had been hospitalised twice in the previous year. If they had been hospitalised once in each of the last four years, they were also eligible.

“This trial is different from the others in a number of different ways. It is multi-state and multi-site, all clinical conditions were accepted, and all patients initially had to be connected by NBN, although that didn’t happen ultimately.”

In addition to improved health outcomes, the project team is also looking at the effect of telehealth home monitoring on existing clinical models of care and the clinical workforce, as well as how to develop sustainable models.

“The benefit of doing that in a multi-state, multi-site project is that it should be relevant to almost all parts of Australia,” Professor Celler said. “We hope to ultimately contribute to government policy by providing high-quality data and a comprehensive economic benefits analysis and to really look at what are the long-term models that will work.

“We are also trying to add value to telehealth with what we are doing. We are trying to develop new risk classifications and algorithms that will be able to use the vital signs data to see whether a patient is sick or stable.”

The project includes a large amount of data capture, including comprehensive questionnaires completed by the patients, access to hospital, PBS and MBS data on each patient and some private health insurance data as well. This has made the project a complex one and did throw up some barriers, including the tedium of obtaining ethical clearance from six different health services.

Professor Celler said the patients had an average age of around 70, most with primary diagnoses of COPD, coronary heart disease, diabetes and chronic heart failure. Some of the patients fit into more than one category, he said.

“[By monitoring the] vital signs, we definitely know when things are changing. What’s really striking about this work is that the vital signs predict when the patient is getting worse by a significant number of days.

“We can do predictive analysis, which is a very important issue in telehealth, because if you have 100,000 patients monitored … you can see where you can provide enhanced services to them to avoid hospitalisation. The measurements are displayed visually, which makes it easier for clinicians to analyse than just figures.”

CSIRO has captured the patient experience in a Youtube video, with the project showing that they are very comfortable using the technology involved.

“For those using it for six months, the results were very positive, with 92.3 per cent satisfaction about using the TeleMedCare device,” he said. “They were very confident in using it.”

Although 20 per cent of the patients withdrew from the trial, this was predominantly due to social and family issues rather than any difficulty in daily monitoring, he said.

However, GP involvement was one of the unexpected barriers. “GPs needed to approve their patients’ participation, and we had to struggle and plea to get them to sign the consent forms. They were very slow in responding to requests for approval to include their patients in the trial. If they didn’t, we couldn’t enrol the patients. That was a major problem.

“Almost one in two GPs declined to take part. We are not sure why because in previous projects we had high numbers. The main reasons were lack of motivation, lack of commitment, too much effort.”

GP preference for receiving regular data on patient progress was also very interesting, he said. Some were none too keen on taking part even though they gave consent. “We had 18 per cent of GPs who didn’t want to know about the project or to access reports. They didn’t want to know about the data.”

On the other hand, some were interested in receiving reports, but it was the method they requested that proved amusing for a technology trial. “Eighteen per cent wanted to have online access [to their patient’s reports], 27 per cent wanted it emailed and 36 per cent wanted it in hard copy by post.”

In terms of cost, the results seem to show the service is economically viable. “We did some costings and came up with a figure for the full Monty – top of the line telehealth management – which comes out to about $12 a day,” he said. “There were low-cost tablet solutions available … so you could get it down to about $2 or $3 a day. There is a huge opportunity for telehealth here that we can capture.”

On the NBN, he said it was substantially better than alternatives. “Connections through ADSL and WiFi imposed an additional workload and I can reinforce the view that the NBN is gold. Things work, the quality of the service was maintained, the quality of the video conferencing is unmatched.”

Telehealth for older indigenous people

Indra Arunachalam, strategic projects manager at home and community care provider Integrated Living, said it was the NBN, not 3G, that made a real difference in telehealth delivery. “It is the gold standard and everyone wants it,” she said.

The Integrated Living project involved providing home monitoring to older indigenous people living in Armidale and Coffs Harbour in regional NSW, Toowoomba in southern Queensland and the suburb of Goodna, which lies between Brisbane and Ipswich.

Using Tunstall equipment, participants monitored their own vital signs, including temperature, blood pressure, weight, pulse, oxygen levels, blood glucose levels and peak flow rate, with the data then transmitted to a central location for nurse-led triage management.

Ms Arunachalam said the nurses were able to quickly respond to out-of-range readings either by phone call or video conference. Data was also available to the participants themselves and to their GPs, who were also able to intervene earlier.

She gave two examples of positive benefits: one a 57-year-old who was quickly diagnosed with a chest infection and prescribed antibiotics rather than having to present at hospital, and another involving a 63-year-old woman who was able to avert an emergency because she was self-monitoring and knew what triggers to look out for.

Participants were confident in the tablet and monitoring equipment as it was easy to use, and Ms Arunachalam said it proved to be very suitable for older Aboriginal people’s auditory and visual learning preferences.

However, compliance with the monitoring was different by site, she said. A monitoring plan was developed for all participants, but in two sites the plan was created by a nurse rather than a GP. The trial showed that GP-developed monitoring plans had significantly greater compliance rates than RNs’ plans.

Overall, the project demonstrated the ability of broadband-enabled telehealth to improve healthcare services, she said. “It enabled flexible and responsive home monitoring by RNs. It facilitated more accurate and timely diagnosis by GPs and improved access to vital signs data and trends.

“It reduced the need for GP and RN home visits and patients were happy that they didn’t have to waste a lot of time travelling or waiting in a GP’s waiting room. Telehealth costs half as much as face-to-face consults with GPs for regular monitoring.”

Nurse triaging was effective, she said, and in every telehealth site, the nurses have spoken very highly of the technology.

“It also allowed relationships to develop between older Aboriginal people and the RNs and GPs involved. Patients reported positive feelings in knowing that they were being cared for regularly.”

Consumer devices for home care

Flinders University took a slightly different tack with its project, plumping for low-cost equipment rather than the top of the range technology used by the CSIRO and Integrated Living. It is using a mixture of iPads, 3G internet and apps like Fitbit to provide home telehealth for rehab, aged care and palliative care in the home.

For rehab patients, apps have been developed to encourage correct exercises and for a falls diary, along with video conferencing capabilities and self-assessment apps. The project also included speech pathology through Vidyo and an electronic whiteboard, all on an iPad over 3G.

Flinders University’s Kate Swetenham said the design of the palliative care project developed largely from the patients involved. They were provided with an iPad loaded with a self-assessment app, along with a case conference capability from Vidyo to enable three-way video conferences with palliative care nurses, GPs and specialists.

For palliative care patients, being able to see their progress mapped was “incredibly confronting”, she said, but they found that the ability to see their GP talk to specialists and the palliative care nurse “incredibly satisfying”.

They also appreciated the ability to stay at home and not have to travel to appointments, she said. “For palliative patients, travel to appointments is a nightmare; travel can be agony.”

There were some challenges, including training participants in using three-way video conferencing, and part way through the trial the Heartbleed vulnerability was discovered, necessitating the reconfiguration of all of the iPads.

Traffic over 3G was also a problem at times, Ms Swetenham said. However, one of the main elements being studied in this trial was sustainability and economic viability, and according to Flinders’ project leader Alan Taylor, low-cost, sustainable telehealth provision is achievable for certain patients using over the counter technology.

Integrated home care

Mat Tyler, project manager for telehealth and eHealth at RDNS, was not able to provide results of his organisation’s trial as it is still in its implementation stage, but said it involves using Samsung devices supported by Tunstall, along with Precedence Health Care’s cdmNet chronic disease management solution.

This trial involves a range of partners and plans to use telehealth to provide integrated GP and nursing care to patients in Victoria, Tasmania and NSW.

He was able to show a video of a patient named James, an American-born 81-year-old living alone in Kingston, Tasmania, who very happily uses a tablet and cdmNet to monitor his wellness in association with an RDNS nurse and his GP.

The widower said he was very comfortable using the technology and was most impressed with its ability to allow him to stay in his home and retain his independence.

Mr Tyler said the results of RNDS’s BEIP project backed this up. “We did a survey before the BEIP project, which showed that 34.2 per cent of people were confident using technology,” he said. “After the BEIP project, that was up to 80 per cent.

“It showed our fleet costs were reduced, as was nurse travel time, and it identified the support model required to effectively deploy telehealth solutions as business as usual.”

CDA use in the PCEHR: lessons learned

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

One of the key foundations of the PCEHR is that the Clinical Document Architecture (CDA), an XML-based markup standard developed as part of HL7 v3, is used for all the clinical documents used in the PCEHR. This article does not purport to evaluate the PCEHR program itself, nor even how the PCEHR program used CDA, but to simply describe the lessons learned from using CDA for the PCEHR.

Why did the PCEHR program use CDA? In May 2007, NEHTA published a document called Standards for E-Health Interoperability: An E-Health Transition Strategy. The purpose of this document was to recommend a standards approach for a broad range of eHealth information interchange requirements, with a particular focus on a national approach to shared electronic health records.

This document rated the advantages and disadvantages of the following four approaches: extending existing use of HL7 v2 as far as possible; a document/ services-centric HL7 v3, based on CDA plus services defined by HL7 (HSSP); CEN 13606; and openEHR. It was a summary of a much larger document that assigned scores for each of these based on a series of criteria.

The second option – CDA plus web services – got the highest score (although all the scores were close), and was therefore selected as the preference.

When the PCEHR project was initiated, this preference became the basis for the general architecture. The HSSP part was replaced by IHE XDS because by then, IHE had published XDS.b, which was based on a web services architecture.

CDA was a late comer to the NEHTA work program. For several years prior to the adoption of the CDA strategy, NEHTA had been working with stakeholders, including jurisdictions, professional colleges, and vendors, to describe a set of information exchanges (information models, and the services that supported them) that had been identified as providing the key opportunities for improving healthcare through better exchange.

These identified packages had their own rich consultation and analysis history, and an existing methodology was used for describing and publishing these analyses. Today, these are published by NEHTA as the Core Information Components and the Structured Content Specifications. These specifications describe the logical contents of the document in a form that is independent of CDA, and therefore reusable in other formats and contexts.

Within the PCEHR program, then, CDA is seen as a technical vehicle for exchanging/ persisting a logical package of data that conforms to pre-existing stakeholder agreements.

Now that the first round of the PCEHR implementation is nearly complete, there are a few lessons that we can learn about CDA.

To read the full story, click here for the April 2014 issue of Pulse+IT Magazine.

Online training for indigenous eye health

The Remote Area Health Corps (RAHC) has partnered with the Indigenous Eye Health Unit at the University of Melbourne to launch what is said to be Australia’s first free online training resources on eye health and diabetes.

The Alice Springs-based RAHC, which offers short-term paid placements for medical staff in remote indigenous communities, will host the resources on its website. It already hosts online resources about ear and oral health as well as chronic disease management for remote indigenous people.

The modules have been developed to meet criteria for continuing professional development programs with the RACGP and ACRRM, as well as the Optometrists Association Australia and the Australian Primary Health Care Nurses Association (APNA).

Hugh Taylor, head of the IEHU, said no indigenous person with diabetes should go for more than 12 months without an eye exam.

“The new eye health and diabetes eLearning module is a critical step in ensuring these annual eye exams happen,” Professor Taylor said.

“Our already established trachoma module has been outstandingly successful and we have recently updated it with information from the new national guidelines.”

Research has shown that only 20 per cent of indigenous adults with diabetes have had an eye examination in the previous year. Treatment such as laser therapy, when used in a timely fashion, is effective in preventing severe vision loss in up to 98 per cent of cases.

Lynden Aged Care goes paperless and wireless

As a standalone, community-controlled aged care provider, Lynden Aged Care is as aware as any that investing in IT systems must have both a clinical and an organisational benefit. With a personally involved board and a CEO with a keen interest in IT, the organisation has made some targeted investments in IT that makes it better equipped than most in the sector.

Lynden Aged Care’s facility in Melbourne’s Camberwell has licences for 30 low care beds, 30 high care beds and 20 extra service places, and is currently undergoing a major capital development project that will add a new wing and accommodate 22 more people with high care needs. In addition, it has recently finished building six two-bedroom independent living units.

It has also gone fully wireless and has made significant investments in the iCareHealth clinical management system, iCareHealth’s medications management system, and the Vocera communications and nurse call platform.

It also has an electronic time and attendance system for staff that allows them to simply scan their fingerprint when arriving at work, doing away with the need for paper timesheets, and staff can also log on remotely to apply for leave or make themselves available for shifts.

For CEO Ann Turnbull, the driving force behind the investments was the benefits she could see from the medications management system. “I saw that at a conference and it was clear to me how much time we would save and how it would almost eliminate medication errors,” Ms Turnbull says.

“Just to set that up was the expensive part because we had to go fully wireless. For that to work properly is where the investment came in, but once you are already wireless the add-on bits aren’t anywhere near so much.”

It was a substantial investment – half a million dollars all up including the infrastructure, Vocera and medications management – but when taking into account the convenience for nurses of the Vocera devices and the time saved on medication rounds, the return on investment is clear, she says.

“Nursing staff just carry one device with them in which they can make and receive phone calls, they can receive nurse calls on it, they can talk to the residents, they can locate each other. There are no telephones and they don’t have to carry a pager or any of that sort of thing, just the Vocera.

“With the medications management system, the main benefit is that the nurses have saved at least an hour every medication round. It has almost eliminated medication errors – that wasn’t a major major issue for us but it’s still something you don’t want to have.

“And because we set that up and the staff really found the benefit from the medication management and the Vocera, they have embraced every other system introduction because they’re not scared of it.”

Ms Turnbull says it helps to have a very involved board that supports investing in IT. “One of the real benefits of a place like ours is that most of the board members have got now or have had a family member living here, so they know what’s good and they could see the benefits of the medication management system and the Vocera system,” she says.

“Their view was that this is why we make money – it is to spend it on residents, not to go into people’s pockets – and they could see very clearly the benefits to the residents.”

With some figures showing that up to half of aged care facilities don’t even have an electronic clinical or documentation management system, Lynden Aged Care is paperless. Asked why other aged care providers do not take the plunge, Ms Turnbull says it usually the cost.

“I would imagine that it is because if you tell them it’s half a million dollars, they would flip out! But the cost benefit is just enormous. We have quite a few staff here who work at other aged care facilities as well and without exception they come back and say this is such a great place to work because it is so easy. They see the benefit so they embrace the other changes that you are bringing in.”

Participating in the PCEHR, however, is another matter. Lynden Aged Care has long seen the benefits of sharing information with other clinicians and providers, and participated in an early shared health record project established by the Inner East Melbourne Medicare Local and its predecessor, but the national system has proved difficult.

The main issue is that it is doctors who have to drive the system, she says, and she is not aware of any of visiting GP who are actively using the PCEHR. As someone who is acutely aware of cost-benefit ratios, the latter is not yet apparent with the PCEHR.

“By the time a person comes in to aged care, they’ve got their GP, they’ve got their relationship with the doctor and if he or she is into the PCEHR, then it will come along without any problems,” she says. “But it has to be done through the doctor. My own doctor doesn’t even have the software to work with the PCEHR so there is no use in me hassling him because it won’t happen. The doctors have got to be set up for it.”

Visiting GPs to Lynden Aged Care are all given access to the iCareHealth system when they are on the premises to make notes or changes to medications, and most are more than happy to do so. For the one who isn’t, a nurse will type the details into the system and the doctor signs it.

“We don’t have any paper so they have to come onto our system,” Ms Turnbull says. “There is no paper for them to write on.”

And while iCareHealth is PCEHR-enabled, it is not being used as yet. Ms Turnbull says the creation of a transfer document in the PCEHR would be very useful, but at the moment there was no benefit to the organisation to drive uptake.

“It would be terrific to be able to upload a transfer document and then when they get to hospital for it to be downloaded again, but to have that you’ve really got to have the residents signed up for it and the doctors participating.

“The GP who has most residents here is really into IT and she loves it. She’s into telehealth, but I’m not sure whether she is signed up to the PCEHR. There just is not the benefit at the minute for us to drive it.”