Towards eHealth Liberation Day: the recovery

In part two of her journey towards recovery from her injury and some of the most tumultuous years in eHealth in living memory, EpiSoft’s Jenny O’Neill finds a silver lining in her other journey towards eHealth Liberation Day.

Hypothesis 6: PCEHR participation improves productivity.

It was a hot summer that year. My mother, my sister and an old friend took it in turns to come around and do stuff. They pottered while I went on with the eAdmissions system for my favourite hospital. You can get so much done when you are forced into the role of couch potato, migrating after a week or so to the role of office chair potato. The patient portal was taking great shape (and yes, congrats on spotting the slightly less subliminal than previous advertising).

By this time, it was my friend Prue’s turn to take up the baton from my sister as chief coffee acquirer and bottle washer. Prue was packing up her flat to move to Afghanistan and storing stuff in my garage. I lent encouragement and reams of advice from the couch.

Prue gave me some advice I’ll never forget. She said that if you have a day when there is no work on either side of that day, that day can deliver a special kind of mental liberation and foster creativity, and improve health and well-being. This was her very cogent argument for why every weekend should be a long weekend.

She was suggesting I forget about work for a while – for a minimum of three full days to be precise – which some business owners with a passion for what they do find really hard to do. But for once, I took her advice and took an eHealth Liberation Day some time in mid January 2011.

eHealth was completely and utterly off the mental agenda for the first time in maybe eight years. Nagging concerns about deadlines and grant applications were simply archived but in this new era of mental liberation, I was still immobile. A romance with the ED doctor was clearly out of the question. Trips to the beach, bike rides and other even more appealing summer attractions (namely pub beer gardens) were out too.

So, still couch bound, it was time to move onto some heavy duty creative – the historical fiction that had been gathering dust in the bottom of a Windows Explorer folder for something like 20 years. Maybe that old thing warranted a dust off and another attempt at completion.

It is another strange thing but as you grow older, the work deadlines, unopened mail, unread emails, unpaid bills and housework dam up the creative inclination like so many twigs strewn across the river. It’s impossible to get into the creative flow until that special day – that day of mental liberation – when there is no work either side.

But then, strangest of all, you realise that for the rest of the year, you’ve been beavering away on business problem solving, software design, process reengineering, marketing and business development so that compulsion to create hasn’t been dammed up at all – just channelled elsewhere. That elsewhere is not like a novel. In eHealth, you can only finish some chapters, never the whole work.

Conclusion: Hypothesis 6 was supported by the evidence.

Hypothesis 7: personal control is not always a good thing.

I went back to the hospital and first thing to do was check out the post-op ankle in the PACS. The amount of hardware in there was enough to make me wonder if some arch villain had done a Wolverine number on me, under general anaesthetic. I clenched the fists a few times but alas no six-inch titanium claws. But the ankle picture was another story – easily six inches of titanium in there.

It was time to seek an expert opinion. The expert was Damien, a former radiographer turned software developer who worked upstairs in the IT department. Who better? I hobbled up to his cubicle, brought up my images and asked him about the screws. Damien said it looked like a very neat job and I shouldn’t worry. After talking to Damien, radiographer-turned-software-developer, I didn’t worry another minute.

Conclusion: Hypothesis 7 was supported by the evidence and rather topical in light of discussions going on at present about ‘curated’ results. Thank goodness for Damien, curator on this occasion.

Hypothesis 8: Plus de change … you know the rest.

By late January, the priority meetings for MSIA were back in the diary. Other industry people, clinical leads, jurisdictional people, NEHTA people, DoHA people and DHS people were all back at the table trying to take the national eHealth agenda forward in leaps and bounds. I still couldn’t walk.

I sat near the door with an extra chair for my boot-encrusted ankle and realised how many of the same people had been at the table last year … and the year before that. Seemed to just bunny-lurch from one boot camp to another that summer.

We were on our way to Canberra in the MSIA’s Geoff Sayer’s car for yet another meeting when the Wave 2 grants were announced. One of our industry colleagues called us. Some did well out of Wave 2, including some in the car that day, not some not so well. I was thrilled that some companies that had been working so hard for so many years were part of the Wave.

However, it was not such good news for us. I was disappointed after all that work and pain and inconvenience and expense (the physio didn’t count me as staff) to see it all come to nought for us, but that’s the nature of the competitive tendering process for you. Mostly it just leads to trauma and lost sleep and we seem to rub along pretty well without them much of the time.

I think that was the day we met Nicola Roxon and her senior advisor. I remember thinking if that was her senior advisor, her junior one was surely an embryo! I also remember that it was a very long walk to the car park in Parliament House for someone with a post-surgical ankle. Would love to tell you what the conversation was about but don’t remember; no doubt it was really important in influencing the government agenda. (In case you missed the sarcastic remark also mandatory in an article from a software vendor, that was it.)

The bad mood lasted a couple of days – but then one of my clients told me to look on the bright side: we could go back to working on our own priorities in eHealth instead of the government’s. That’s a new slant on eHealth liberation day. And so we, like many others, just knuckled down and got on with business as usual – the business of continuous improvement through eHealth, the business of selling solutions not widgets, the business of juggling numerous competing priorities in a complex environment and the business of designing and implementing useful technology.

At some level, it is hard to see that there ever was an eHealth Wave, much less two. Everyone now just seems to be back in business as usual mode as if it never were. On another level, to not recognise the extent of the achievements of those individuals who sat down at the table so often during the Wave era to get things agreed and get on with the daunting national agenda would be unconscionable.

It is largely due to this group that we now have a functioning national health identifier service, national framework for secure message delivery, a national framework for secure authentication, a PCEHR that healthcare providers can connect to, a technology framework for continuous improvement at a national level and a much greater focus on consumer engagement. I was proud to be a little part of that eHealth journey; collectively we wrote some mighty big chapters, albeit some of them are still in first draft.

It seems fitting at the time of my departure from the MSIA board to acknowledge those people who were most often at the table during the Wave era: from the MSIA Jon Hughes (SmartHealth), Geoff Sayer (Healthlink), Vince McCauley (McCauley Software), Emma Hossack, CEO Bridget Kirkham, John Green and Margaret Prichard.

From the wider industry, Michael Legg (Michael Legg & Associates), Caroline Lee (LeeCare Solutions) and past president of ACIVA, Russel Duncan (Emerging Systems) and a member of the AIIA’s eHealth group; and NEHTA clinical leads Nathan Pinsker, Mukesh Haikerwal and Marina Fulcher.

From the state health departments, Ian Betheras, Peter Williams, Judy Redmond, Ian Bull, Rob Whitehead; from NEHTA Les Schumer, Bettina McMahon, Heather McDonald; from DoHA Paul Madden, Matt Corkhill and Liz Forman; from DHS Jo Hammersley, Monique Warren and Angela Morello; and from the healthcare consumer groups, the indefatigable eHealth stalwart, Peter Brown.

There were so many more but these people seemed to be at just about every meeting from 2010-2013 to work through the difficult problems and lay the foundations of our national eHealth infrastructure.

So I hope this group and everyone else in the eHealth sector takes a liberation day from eHealth and at least two days (though ideally several weeks) either side. Recharge the batteries for another year. Because some mighty big chapters have been written but we’re still a long way off the whole work.

So many lessons learned from one little transient imHealth event. And so adieu. I’m off to enjoy the therapeutic benefits of a long weekend.

Jenny O’Neill is the executive director of medical software company EpiSoft. During the tumultuous period between 2010 and 2013, she was vice-president and president of the Medical Software Industry Association (MSIA).

Towards eHealth Liberation Day: the falling

This is the tale of one person’s eHealth journey, from laundry basket to hospital to the PCEHR and beyond. A goat makes an appearance, as does a handsome ED doctor, but for EpiSoft’s Jenny O’Neill, the day-to-day business of eHealth continues as the experience of 2010-2013 fades into memory.

Are you tired of those conference presentations where the speaker regales you with their own Close Encounter with the Healthcare System – the inefficiencies, the lack of co-ordination, the repetition of one’s health history details over and over? The speaker’s personal experience of their ‘patient journey’ is invariably used to highlight the need for further investment in eHealth.

And don’t you find it tedious when people draw long bows and make grossly generalised statements from their own personal experience? It’s not quite so annoying as people who know nothing about eHealth pointing out that if the banks can do it, why can’t the health sector? No, it’s definitely nowhere near as annoying as those ridiculous analogies – but it’s up there.

If you, like me, find personal eHealth journey stories really annoying and verging on the patronising to an increasingly sophisticated eHealth consumer group, stop reading – now. Or if you prefer, read on, because this is a personal eHealth journey with a twist.

It is no heroic battle with a serious chronic illness and medical misadventure due to inefficient paper-based processes. Far from it. This was a simple, easily resolved acute health issue involving the usual players (doctors and hospitals, patient and carers) and the usual mix of paper and electronic systems, but that has not stopped me drawing a number of long bows (see hypotheses below) from one’s personal experience, not in mobile health (mHealth), but in immobile health (imHealth). So let’s draw…

Hypothesis 1: Participation in PCEHR increases falls risk.

My personal eHealth journey story begins on a hot December evening in 2010 (it could have been dark and stormy to fit the plot but inconveniently, the sun had not yet set on a glorious day) when the PCEHR Wave 2 grant applications were due for submission just prior to Christmas. The rest of the nation was winding down around about this time, going out to lunch to celebrate a bumper year witnessing Armani-suited psychopaths from Wall Street at the economic rudder of the world steer the entire planet into an economic meteor storm.

Meanwhile, the local eHealth industry and its clients and pals were feverishly pulling together consortia and compiling over 90 compelling arguments as to why their particular eHealth project deserved some grant funding under Wave 2. Because healthcare is immune to economic recession, don’t you know?

The medical software industry was enthusiastic about Wave 2. We had blinked and missed Wave 1 and we trust some good somewhere came of that $insert-eyewatering-sum-of-money-here, but now here was a chance for all parties to compete on a level (level so far as we knew) playing field. A call for the so-called Wave 2 grants.

While a lot of healthcare providers submitted these grant applications under their names, their partners in the software industry did a lot of the ghost-writing. In my case, this was not ‘ghost’ in the sense of being invisible so much as ‘ghost’ in the sense of staying up until the wee small hours developing an unhealthy pallor and moaning about how little time there was to pull together a compelling story.

And now here’s the twist: after about four such nights spent thus and with the duties of ghost still incomplete, I made the mistake of pausing briefly in this marathon write-up and endless round of teleconferences and emails to undertake some long overdue domestic duties.

Piling the washing basket to way above eye height, I carried the basket out the back door (the step was about a three-inch rise), my foot slipped off the side of the doormat (a one-inch rise), the washing basket fell and dirty clothes spewed out across the verandah and covered the dog.

That was the entertaining part. The not so entertaining part was the sickening snap that followed the twist – the meaning of that old cliché made itself known the very next second. I heard my ankle bone snap and it made me feel sick, so sick I couldn’t get up, couldn’t even crawl back through the kitchen door.

Ligaments, bones, the whole complicated anatomy of a major joint was in screaming, burning protest at the treatment meted out by its sleep-deprived owner. A white veil descended over my vision and I stayed on the ground with elbow and head in the dirty washing till the kids came home. If I’d been just a few more steps down my personal eHealth journey – had I been coming back from the clothesline – it would have been clean washing and the situation would not have been quite so dire.

The neighbour had recently lent me his goat to get the lawn under control. Carl was brownish-grey with disconcerting boggling pale blue eyes and a tendency to be derelict in his duty. Carl ate the bushes and gnawed through the electrical cord of the fairy lights around the back verandah, but decided to completely ignore the lawn.

Carl was dead interested in the injured human and the dirty washing festooned over his back verandah. He came over for a closer look. You do not want a goat peering at you when you’re about to pass out. Trust me on this. They look cute dotted on a distant green hillside eating grass when they can’t get fairy lights but they are seriously creepy up close.

Carl was more effective than smelling salts – you don’t pass out when up close and personal with a goat for fear of being damned for all eternity.

Fortunately my kids weren’t too long getting home, getting me inside away from the imminent threat of evil and administering the RICE treatment. After a brief spell on the couch, during which we all vainly hoped that the rapid swelling was just a nasty sprain, I mentioned in a spectral drawl the two letters that fill all healthcare consumers with dread and make teenage boys positively quail – Eeee…Deee.

Being regular attendees at the local hospital ED after way too many seasons of school rugby, we at least all had the presence of mind to pack a good book.

Conclusion: Hypothesis 1 was supported by the evidence from my personal eHealth journey.

Hypothesis 2: Participation in PCEHR causes relationships to fail (before they even begin).

The next stage of my eHealth journey was a test of endurance, an ungainly slide down the front steps, an even less ladylike flop into the back seat of the car and a part-lurch, part-hop up to the front counter of the ED.

Registration and triage happened like clockwork and out came all the good books while we settled in for the most tiresome part of any eHealth consumer’s journey: the Wait for the ED Doctor.

He turned out to be tall and handsome and somewhere in the neighbourhood of my age and under ordinary accident and emergency circumstances, such attributes would have made the wait worthwhile, but these weren’t ordinary circumstances. Here I was, a middle-aged female in gear fit to meet a clothesline, ankles that had experienced too little recent personal attention for close scrutiny by an old pal much less a tall handsome ED doctor, and sporting a ghostly Wave 2 PCEHR complexion.

I hoped the doctor would think the pain was making me wince but when he got the x-rays back, he told me it was as he suspected: my ankle was smashed to smithereens and my pain threshold was off the scale, so he wasn’t fooled for one minute about what was really causing the pained expression.

Conclusion: Hypothesis 2 was supported by the evidence from my personal eHealth journey.

Hypothesis 3: The right information at the right time in the right place will save the consumer time, expense and inconvenience.

There was a computerised front desk, a computerised nurse triage process, a computerised expected waiting time with algorithm designed by the head of department, an uncomputerised encounter with the emergency physician (I really wished he’d had a computer to look at), a non-computerised referral to radiology, a computerised record of my visit in radiology, a paper letter of referral to an orthopaedic specialist and a visit next day to the orthopod’s office who had my image up on the hospital’s PACS web viewer, the operation planned and the surgery booked before I could bunny-lurch my way over to the seat in his office.

Where is telehealth when you need it? The x-ray was evidence enough of what needed to be done. The only benefit of a face to face was some serious practice on the crutches over a few hundred metres of broken pavement. I was impressed the surgeon had a picture of my ankle on the PACS web viewer. He was impressed too. The IT department had only just got it working on his Mac.

We talked about that for a while (platform and software compatibility, browsers and PACS, you know the usual stuff). I gave him some advice on who to contact for his next IT issue with the hospital (did some work in the IT department you see, so could drop a few names). I was fully diagnosed with a surgical plan before walking in the door and after a half hour getting from the car park on crutches, the appointment was over in about five minutes.

Notwithstanding the fee for outpatient attendance, which was clearly the only reason I had to put in a personal appearance, turning the consult into an eHealth advisory session clearly paid off. The orthopod gave me a staff discount in the mistaken belief (which I accidentally forgot to correct) that I was on the staff at the hospital. (Well, contractors who hang about for a long time can be quite as hard to get rid of as staff so it almost counts.)

Conclusion: Hypothesis 3 was not supported by the evidence from my personal eHealth journey but in the later stages of the study, some conflicting results were noted.

Hypothesis 4: Build it and they will come.

Next step was completing the six pages of hospital admission forms. Rather unfortunate timing as my own company’s eAdmissions system was not yet live at this hospital at this time so I had to fill in the six pages using the dying art of handwriting (in my case, being sinistra, an art never mastered in the first place).

Conclusion: Hypothesis 4 was tested using the negative hypothesis (don’t build it yet and they won’t come) and this was supported by the evidence. A longitudinal study on the subject over the next few years further supported the hypothesis that if you build something useful, there is a reasonable statistical likelihood it will get used.

(And just in case you missed the less than subliminal advertising, that’s the plug for one of my company’s eHealth products – mandatory inclusion for all articles written by a software vendor.)

Hypothesis 5: eHealth is essential ingredient in the safe and efficient delivery of healthcare.

The day of surgery went smoothly and no less than five people from the IT department came to visit beforehand. They must have heard on the grapevine and somebody must have been keeping an eye out for me on the computerised surgical list because they arrived five minutes after the nurse had admitted me. Somebody with a privacy hat on might be concerned about that but these five were motivated by concern for a colleague and a friend and I was humbled by the camaraderie.

That computerised algorithm for calculating time in operating theatre I had worked on a few years back with a statistician from Macquarie Uni was clearly paying dividends because this was production-line efficiency at its absolute best. In spite of staff in day-of-surgery admissions using a mixture of computer and paper, nursing staff in the pre-op holding area using a computer, staff in the theatre using paper, the anaesthetist popping around for a paper-based chat and the surgeon not to be found once I got to the OR (he was having coffee – we didn’t factor that into the algorithm), the waiting times were minimal.

The process from admission to ward was like a well-oiled machine, oiled (truth be told) not by the algorithm but by nurses and doctors with decades of experience.

Speaking of oil, the post-op evening was spent on the good oil in the form of some serious pain relief but the morning turned into serious boot camp for serious boot wearers. Mine was black with Velcro ties and grey padding, like a large ski boot. The nurse who gave me a quick demo on how to do up the boot and self-administer Clexane injections said, when I whimpered and expressed grave doubts about one’s ability to jab one’s own stomach with a needle, “Little old ladies who’ve had total hip replacements can manage this fine”.

She didn’t say “so why can’t you, you wimp!” out loud but I heard her loud and clear. I was glad the emergency doctor who had been a bit impressed by the injury-related pain threshold was not here to witness the timidity about needles.

The physio made the nurse seem like a professional agony aunt. She made me go up and down a set of stairs with crutches, insisting that I couldn’t be discharged till I had passed this ridiculous endurance test. I guess mastering crutches is like riding a bike – if you learn as a kid you never forget. The trouble was I was falling over and getting countless stitches throughout a clumsy childhood but by some weird twist of fate, never managed to break a bone, so had never learned crutches.

The one-metre-high staircase may as well have been Nanga Parbat. Insurmountable. The physio instructed, she cajoled and tried with moderate success to hide her frustration while I made several clumsy and red-faced attempts. My boys had arrived by this time and, anxious not to hang around a hospital ward any longer than was strictly necessary, they called encouragement and instruction from the sideline. They didn’t say ‘Get on with it, Mum’ out loud but I heard them loud and clear.

In the end, the physio stepped out for a moment, the boys stepped forward and with half-shove and half-lift, got me up the stair. The physio came back and there I was at the summit, triumphant in my cheating glory. The ordeal of that boot camp was over. I was ready for discharge.

And so home with two weeks’ supply of Clexane, the Wave 2 grant got written (couldn’t walk so may as well sit and finish that), my boys went off to New York and the real Florences of the world arrived to take control. First came my friend Sally to administer Clexane, which she dutifully did for a couple of days but I couldn’t very well ask her to come Christmas Eve when she was cooking for an extended family of 12 people.

It did seriously cross my mind to ask her, but no, that would be stretching the friendship a bit far. It was time to learn some self-sufficiency. Thinking all the while about the stoicism of little old ladies post their total hip replacements, I became quite a dab hand at self-injection.

And while on the subject of little old ladies, the next Florence on the scene was my mother. Mum is no stranger to medical misfortune, having survived three primary cancers, an asthmatic child who needed a lot of medical attention in the early years (known allergies were to house dust and school), and a husband who needed constant care in the last years of his life.

We went to my sister’s place for Christmas. Mum drove. Boundless sympathy notwithstanding, my mother does not fit the archetype of little old lady behind the wheel of a car, where she is a veritable lunatic. Picture being strewn across the back seat with a boot on the window sill, careering along narrow country roads with an octogenarian hoon with macular degeneration at the helm. One’s pain threshold may be high but there were plenty of other good reasons to develop a short term addiction to narcotics.

Conclusion: Hypothesis 5 was not supported by the evidence from my personal eHealth journey. There was overwhelming evidence that eHealth was only a small prop on the stage supporting a veritable ensemble of talented and dedicated care givers.

Hypothesis 6: PCEHR participation improves productivity.

To be continued …

Jenny O’Neill is the executive director of medical software company EpiSoft. During the tumultuous period between 2010 and 2013, she was vice-president and president of the Medical Software Industry Association (MSIA).

NBN commits to fixed wireless and satellite

Those rural and remote communities promised a connection to the National Broadband Network (NBN) either by fixed wireless or satellite under the scheme’s original plan will remain part of the roll-out, but other areas hoping to receive fibre to the premises (FttP) are likely to miss out.

NBN Co today released a statement of principles determining which technology will be deployed under the government’s revised “multi-technology mix” (MTM) approach.

Under Labor’s original plan, 92 per cent of Australian households and businesses were to receive high-speed fibre to the premises, but following the election of the Coalition government those plans were ditched in favour of a mixture of fibre-to-the-node (FttN), fibre-to-the-basement (FttB) and the reuse of Telstra and Optus’s hybrid fibre coaxial (HFC) cable.

NBN Co says it will complete existing deployments of FttP, but other sites are likely to receive FttN or FttB. While broadband speeds are claimed to be higher than existing ADSL2+, both of the latter technologies rely on Telstra’s ageing copper network.

NBN Co CEO Bill Morrow said the company was considering a fibre-on-demand product, in which individuals or businesses that wish to purchase fibre to their premises can do so.

He also said NBN Co would work with small communities that choose to co-fund FttP if they are in an alternative technology area.

While the announcement that rural and remote communities will receive the technologies originally promised was not unexpected, the announcement finally puts to bed the original plans, which would have delivered far higher speeds and more reliable connections than the MTM model but at a higher price.

NBN Co said that for each service area, it will consider whether existing infrastructure can be used as well as local construction capabilities. It will also consider whether advances in technology may mean an alternative approach may be preferable.

For areas that have very poor or no broadband, “NBN Co will prioritise areas identified as poorly served to the extent commercially and operationally feasible,” the company said.

Poorly served areas were delineated in a broadband availability and quality report released late last year, highlighting the Northern Territory, Tasmania and Western Australia as having more areas with poor access to quality broadband services compared to the remaining states.

“Overall the analysis found that there are areas of inadequate access to infrastructure across the country – approximately 1.4 million premises (13 per cent) are in areas where fewer than 40 per cent of premises can access a fixed broadband service,” the report found.

“The premises in this category are typically located in regional or remote areas of Australia, or in small pockets of poor service in metropolitan and outer metropolitan areas.”

Telstra takes a stake in Orion Health

Telstra Health has invested $NZ20 million ($A18m) in Orion Health, representing about two per cent of the company’s shares.

Orion Health completed a book build last week to set a price for its stock in advance of its initial public offer (IPO, which it has now set as $5.70, at the top of its indicative price range.

Orion Health said in a statement that the IPO raised $125 million, comprising $120 million of new capital and a $5 million sale by CEO and founder Ian McCrae.

Orion said Telstra Health joins over 20 new institutions who will become shareholders in Orion Health as part of the IPO.

Mr McCrae said that in addition to Telstra’s investment, the two companies would work together on eHealth initiatives for the Asia Pacific region.

Telstra Health MD Shane Solomon said that the investment reflected Telstra Health’s ambition to be a leading provider of integrated eHealth solutions.

“To create a truly connected health care system means working with providers, government and funders as well as some of the world’s best and most innovative solutions,” Mr Solomon said. “Orion Health is a world leader in this sector and we are excited to work with them.”

Orion Health is expected to commence trading on the New Zealand and Australian stock exchanges on November 26 under the code OHE.

Both Telstra Health and Orion Health have announced they are making big plays in the health IT market. Telstra announced its strategy last year, purchasing or investing in a number of eHealth companies, along with the big announcement last month that it would launch a telehealth solution in 2015.

Orion Health has restructured its solutions groups to better reflect its strategy, part of which is the IPO to raise money to invest in research and development.

Myco promises quick access to alarms without the fatigue

Ascom Integrated Wireless has officially launched its new Myco mobile device, specifically designed to improve nurse workflow and reduce alarm fatigue, to the Australian market.

Myco is a smartphone that can be integrated with communications technologies such as nurse call systems and patient monitors to receive alerts and alarms, but also to a secure messaging system to allow the nurse to communicate with doctors and other hospital staff securely.

Alerts and alarms are immediately shown on Myco’s top display, providing the nurse a hands-free way of quickly deciding whether to attend to the alert or reject it and pass the message to other members of staff. It also allows the nurse to connect to patient monitors to see the full picture if required.

It is 3G and WiFi-enabled and is soon to be DECT-enabled as well, the managing director of Ascom Integrated Wireless, Leo Silver, said.

Running behind the device is a middleware product suite called Unite that allows it to integrate with hospital clinical information systems such as laboratory, radiology and pharmacy, as well as a software developers kit (SDK) that can interoperate with third-party apps.

While the device is designed for nurses, Myco also has a sister app that can be downloaded onto other smartphone devices, such as the iPhone and Android 4.x models, to allow other members of staff to view the same alerts and alarms on their own devices.

Mr Silver said the Myco device had been developed specifically to address an emerging problem for nurses – alarm fatigue.

“As we are moving towards the digital hospital with networked clinical systems, we are generating more alerts, alarms, messages … and typically we are presenting these directly to the frontline caregivers,” Mr Silver said.

“We are swamping the frontline staff, the nurses, with alarms, beeps, messages left right and centre, and that alarm fatigue is the critical area that Myco is targeted at.

“The negative issues we are seeing results in two areas. Firstly is distraction – it’s hard to focus on your role when these things are going off on your hip … and also at desensitisation towards alarms. Alarm fatigue puts people at risk.”

While many hospitals still don’t have a BYOD policy – and often restrict access to personal devices for security reasons or refuse to allow them – a recent Spyglass consulting report from the US shows that clinicians are still using their smartphones at the point of care, Ascom Integrated Wireless’s sales and marketing director, Feargal O’Farrell, said.

“BYOD is a wave that is building … and it will be crashing on the shores very soon,” Mr O’Farrell said. “We know that from reports like the Spyglass Consulting report stating that out of the 89 per cent of hospitals surveyed, they do not have a BYOD policy.

“However, the reports are also showing that 67 per cent of nurses are using smartphones at the point of care. The reason for that is they need access to information applications, they need access to applications like Medscape where they can get access to information on things like medications interactions, conditions, procedures and get that kind of background data.

“They need things like secure messaging, they need to be able to contact doctors, surgeons, consultants who are notoriously hard to get on the end of a phone. And they need to talk patient-specific information, so they need an encrypted path to do that.

“The final thing they need also is the ability to easily and readily communicate with their colleagues in the same building, in the campus. So they also need a chat function that allows them to do that but also a secure environment, so it is encrypted and cannot be used for the wrong purposes. The demand is coming from the point of care – the nurses and caregivers.”

Mr O’Farrell said one of the differences between Myco and a standard smartphone is the top display, which has been designed so nurses can wear Myco either clipped on to their scrubs, in their pocket, or clipped onto the waist or a belt.

“The top display is located there and it’s integrated so that carers, when they receive an alarm, they can tell the type of alarm, the severity of the alarm and the location of the alarm without even having to touch the device,” he said.

“The top display is integrated so we don’t disturb them from doing what they are doing. We allow them to make very real decisions on critical alarms, minor alarms, and they can make those decisions very easily.”

Mr Silver said Myco was both 3G and WiFi-enabled to allow nurses to make voice calls over either network. Ascom has taken the wireless LAN chip and the SIP telephony software from the company’s heritage i62 product and used it in Myco, which he said opens up the product to common networks and communications platforms from the likes of Cisco, HP, Aruba and Alcatel-Lucent.

“The clinician in the working environment will have the same device, with the same applications with the same communication suite, available to them in campus, typically over the WiFi network at the hospital, but also remote, maybe to another campus, maybe to another building, maybe to the patient’s home, or in between and in transit,” he said.

“We see the 3G, WiFi combination in one device as quite unique and a real differentiator for Myco.”

While there is a lot of smarts behind the whole system, including enterprise-grade interoperability features, Mr Silver said systems were often judged simply by the features of the handset. The handset is waterproof and has been ruggedised for the hospital environment, and can be cleaned with an alcohol-based wipe.

“It has a camera built in that can do 1D and 2D barcode scanning; it has been designed with applications that let you do closed loop medications management,” he said. “The battery is designed to last all shift, and at the end of the shift you can simply unclip the battery and put a new battery in. It is designed to work well in hospitals.”

Mr O’Farrell said Myco has been designed around the nurse, but that it can interface with the devices such as an iPhone or Android device used by other clinicians and administrative staff.

“That’s their device of preference and that’s the device they’ll take everywhere they go, so why should they take a second device with them? What we’ve got to handle that situation is we’ve taken some of the messaging features from Myco that can then be put on a small application that runs on their smartphone. This application is called Unite Axess.

“Anyone carrying an Android phone can have this smartphone application set up and they are part of the workflow and they can receive those alerts and messages just as they would if they were using a Myco.”

Ascom has partnered with a number of healthcare equipment and clinical information manufacturers such as GE to enable the device to interact with those third-party systems. GE Healthcare Australia’s market segment manager, Paul Merrett, a former ICU nurse, said the launch of Myco was a significant step forward.

Mr Merrett said that by allowing a nurse busy in a drug room, for example, to easily see the nature of an alert, they can then quickly decide whether to respond or pass it on to another nurse.

“You are not dropping everything that you are doing,” he said. “You can accept or send a busy signal and give it to someone else, and have an escalating process. This in itself is a huge paradigm in workflow for nurses. You are suddenly carving off an enormous amount of time, energy and stress, and that nurse can make an immediate clinical decision.”

By using Unite as middleware between the device and GE’s patient monitoring equipment, for example, the nurse can also bring up more detailed information about an alert, he said.

“If the single lead ECG is not enough information for the nurse to make that decision, then we can log into the central station and bring up the full monitoring screen on that handset itself,” he said.

“What this does is bring patient monitoring to the nurse. That in itself is more than a paradigm – it is an enormous leap forward.”

Ascom Integrated Wireless said Myco will be available in the first quarter of next year, with a range of pricing models to be released in the next month or so.

While it is designed for the hospital setting, it will also be marketed to nurses in residential aged care.

Opinion: Is your clinic prepared for BYOD?

In a professional sector where security is essential, bring your own device (BYOD) is surprisingly common in healthcare, with staff members using their own portable devices (whether tablet, smartphone or laptop) to perform work-related tasks.

With hardly a week going by without a news story involving a high-profile data breach where customers’ personal and financial information are compromised, this can be an even more worrying scenario for healthcare professionals, given the importance and sensitivity of electronic health records and related billing information.

In general, BYOD adoption is driven by medical professionals seeking to improve efficiency and not by IT professionals who recognise the risks involved if BYOD is not introduced in a way that secures data. Medical professionals, quite rightly, focus on patient care and leave security concerns to their administrators and IT teams.

In traditional companies, BYOD introduction is formally launched by an executive team that consists of legal, HR and other involved departments. A HR policy is drawn up that employees must agree to before being allowed to use their device on company networks.

In effect, the employee is granting the company access to their personal device, to install partitioning software (which segregates personal data from business information) and other apps that allow remote wiping of data if the device is lost, stolen or if the owner leaves the organisation.

If remote wiping is necessary, personal data is sometimes lost, hence the necessity of a HR policy.

For healthcare facility owners, practical steps for safe BYOD implementation should include:

BYOD costs can vary, with some companies supplying the devices to staff members and others happy to allow staff members to use their own. In addition, some offer a shared ownership-type facility where costs are shared.

Regardless of the payment method, most businesses will insist on approved manufacturers or platforms – some are more comfortable supporting Android devices while other prefer Apple devices.

Therefore, staff members need to:

In addition, there are legal concerns. In the event of a court order requiring e-disclosure (known as e-discovery in the US), an employee is compelled to surrender their personal device for forensic examination and extraction of required company data.

While the area of e-disclosure is relatively new in Australia, it is worth noting that US employees who have destroyed company data have paid substantial damages as fines were levied against both the company and the employee involved, even though the device was personal property.

The same logical approach to BYOD introduction is advised for healthcare, in addition to compliance with local legislation. It is best if data does not reside on the device but instead located in the cloud or a secure local server, for example. Access levels are determined by role, with senior-level staff having corresponding access permissions.

A casual approach to BYOD is a recipe for disaster and clinics should investigate their options, hiring outsourced solutions where necessary to recommend the best approach for their clinic. Compliance tools, security software, document management strategies and disaster recovery tools are identified in advance.

Perhaps the single most important aspect of BYOD is the creation of a comprehensive yet adaptable policy that meets the requirements of the business and also of staff members. Information that is unwittingly leaked by a staff member, for example, will see patients moving to other clinics, ones that value their health records and protect them diligently.

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

HIC 2014: Hansen steps up as new chair of HISA

The Health Informatics Society of Australia (HISA) announced the new members of its board and its annual award winners at the Health Informatics Conference (HIC 2014) in Melbourne this evening.

The new chair of HISA is David Hansen, CEO of the Australian e-Health Research Centre (AEHRC), a joint venture between the CSIRO and the Queensland government.

BT Australia’s Karen Gibson, a former HISA board member and former general manager of strategic initiatives at NEHTA, was elected vice chair.

Jen Bichel-Findlay and Phil Robinson have been returned as secretary and treasurer respectively, along with current ordinary members Nick Buckmaster and Tam Shepherd. New board members are Accenture’s Leigh Donoghue and Edith Cowan University’s Trish Williams.

The winners of the Don Walker Awards for efficiency, effectiveness and access were:

Carey Mather from the University of Tasmania was awarded the Joan Edgecumbe Scholarship.

James Bennett won the HISA Apps Challenge with the DoseMe app, which also took out the medication management category of the challenge. Other finalists were Jennifer Tang and Jarrel Seah with Eyenaemia, Dhruv Verma with PROTEGO, and the Northern Sydney Local Health District for the Traffic light guide.

Dallas Bastien of Nursing Review won the media award.

The academic awards for scientific papers will be announced at the conclusion of HIC 2014 on Thursday.

HIC 2014: Telstra rejects rumours it wants to take over PCEHR

Telstra Health has moved to quash rumours that it plans to build a national eHealth platform that would take the place of the PCEHR, saying its strategy to invest in six different areas of eHealth capability is complementary to the national system, not a rival.

Telstra Health revealed at the Information Technology in Aged Care conference in Hobart last month that it is working on a method to bring the silos of information held in GP, pharmacy and aged care software systems together and said it plans to release more information on this platform in the coming months.

However, at the Health Informatics Conference (HIC) in Melbourne yesterday, Telstra’s head of health, Shane Solomon, rejected rumours that this new platform would take the place of the PCEHR, or that the company planned to make a bid to take over the system.

Telstra has ignited interest in the eHealth industry with several acquisitions and investments over the last 18 months in a number of health IT companies, including HealthEngine, Fred IT, Health Connex (formerly DCA eHealth Solutions) and Verdi.

Asked in a Q&A session by ABC journalist Tony Jones if the company was positioning itself to take over the eHealth record system, Mr Solomon said no. He said the new platform Telstra was developing was a fundamental part of the company’s strategy, “but it is not about the PCEHR”.

“It is about connecting islands of technology and islands of information,” Mr Solomon said. “We believe that to reduce hospital readmissions you have to use multiple technologies, not just a record.

“The record is a part of it, and a critical part of it that we would love to be able to extract is what I define as the PCEHR – not the view, which is badly designed – [but] the data that is behind the view.”

Mr Solomon said that now that the government had established some foundations for a national eHealth system, the private sector can begin to build value-added technologies for it.

Responding to criticisms of the design of the PCEHR, Department of Health CIO Paul Madden accepted that it was not a user-friendly record but argued that it was a starting point. He also accepted that the methods chosen to communicate the existence and potential benefits of the system had been poor.

Mr Madden said that with the review of the system completed and another year’s worth of funding allocated, the federal government had shown it was committed to the system.

“The government is committed to an eHealth strategy, but one that is a working eHealth strategy that delivers the benefits,” he said. “Now, we need to get a system which is unified and supported by and depended on by clinicians, the patients and the consumers, and when I say clinicians it’s all of the people in healthcare provision.

“[W]e haven’t made this particularly intuitive or user friendly. We haven’t done it through the eyes of the clinicians … We need to find out how to bridge that gap between informaticians and … the grassroots GPs.

“We did spend a few years trying to communicate what was happening in eHealth and that didn’t permeate to the level that was needed. The new approach that we need to work on is how to take those messages directly to the community.

“The way to teach people how to use a computer system is to sit with them and let them use it so they build confidence. You don’t show them on a whiteboard, you don’t do it in a webinar and you certainly don’t do it on a set of Powerpoint slides.”

HIC 2014: Wearable tags to track the elderly on the go

An RFID-based real-time location system that can pinpoint exactly where elderly people are in their homes and track their movements is one of four apps competing in the HISA Apps Challenge, to be announced at the Health Informatics Conference (HIC) in Melbourne tonight.

Designed by 14-year-old Melbourne student Dhruv Verma, the PROactive Technology for Elderly on the GO or PROTEGO app is a concept aimed at providing a cost-effective way of monitoring the elderly at home that can alert family or carers if the person has not moved or has potentially had a fall.

Dhruv has designed the real-time location system using RFID tags and wireless antennas as a cost-effective alternative to other systems such as wristbands or pendants, which elderly people are liable to take off or forget to wear.

The signals emitted by RFID tags are strong enough to be picked up by the antennas and are able to pinpoint the exact location of the person in the home in real time. “And it is cost effective,” Dhruv said. “The tag costs about eight dollars and the antennas cost eight or nine, and you can probably wire up the whole house for a few hundred dollars.”

There are other systems on the market that use sensors attached to everyday objects, such as teapots or fridge doors, but Dhruv’s concept aims to be more exact by making the RFID tags wearable.

“My solution is an RFID tag as part of a self-adhesive waterproof patch,” he said. “I’ve got a prototype but my vision is to make the tag even smaller and use smaller button batteries so it can be applied comfortably onto the elderly person.

“The battery life is about six or seven months and the patch you would probably need to replace every two weeks. That can be done by a family member.”

The concept also involves an app for smartphones or tablets so family members have a view of the layout of the house and exactly where the older person is.

“It will be a dot showing the person that will be either green or red or orange,” Dhruv said. “Green will be he’s all good and he’s walking around the house. Red will be he has fallen down and he hasn’t moved for a while, and orange will be he hasn’t been moving for five minutes, and after that five minutes it will become red.

“There will be smarts with the software that will let you know if they haven’t moved for a certain amount of time. That will alert you by a notification to your phone. On the phone will be a house plan of the house where it will tell you the accurate location of the elderly person currently, and also track their steps around the house in real time.”

He believes the concept will prove a superior alternative to GPS systems, which rely on the accuracy of satellites and are designed mainly to track a person outside the home, and stationary sensors that do not provide real-time information.

Dhruv is currently interested in hearing from app developers, universities or investors interested in furthering the concept. He can be contacted by email or on Twitter at @dhruv_verma1.

Budget 2014: $140.6m for PCEHR for one year

The federal government has allocated $140.6 million for the 2014-2015 financial year to continue the operation of the PCEHR for one year while it considers its response to the Royle review into the system.

The Department of Health itself will undergo a “capability review” from June “to ensure it has the processes, systems and expertise in place to deliver the government’s policies and achieve results for the Australian public”, while the government appears to have accepted John Horvath’s report into the function of Medicare Locals in full.

Medicare Locals are set to be renamed Primary Health Networks from July next year, the budget papers say, with funding to come from the existing resources of the Department of Health.

On the PCEHR, the papers say that the government will fund the system to the tune of $140.6m – $118.8m for the Department of Health, $20.8m for the Department of Human Services and $100,000 for the Department of Veterans Affairs, along with $1m to DHS in “related capital” – for the 2014-15 period.

It will also “continue to work with stakeholders with regard to the recommendations from the recent review of the PCEHR to determine how best to proceed with national shared electronic health records, to support improved productivity across the health sector and greater convenience for providers and patients”.

The eHealth Practice Incentives Payment (ePIP) program will continue, and the planned evaluation of the Telehealth Pilots Program will also be conducted, with the pilots concluding at the end of September 2014.

From July 2015, previously bulk-billed patients can expect to pay $7 for a standard GP consultation and for out-of-hospital pathology and imaging services.

By July 2015, the government will contribute approximately $37.70 for each typical GP service, less $5 which will to be diverted to a new Medical Research Future Fund. The fund is designed to grow to comprise $20 billion within six years, allowing for the provision of medical research expenditure of around $1 billion by 2022-2023.

On Medicare Locals, the budget papers say the government will move to establish Primary Health Networks (PHNs) from next July, in line with Professor Horvath’s review.

“There will be fewer, but larger, PHNs in the new network that will replace Medicare Locals,” the budget papers say. “PHNs will be clinically focused and responsible for improving patient outcomes in their geographical area by ensuring that services across the primary, community and specialist sectors align and work together in patients’ interests.

“In 2014-15, PHNs will be established through an open and competitive tender process in readiness for operation from 1 July 2015. The Commonwealth will no longer fund the Australian Medicare Local Alliance from 30 June 2014.

“PHNs will be aligned to Local Hospital Networks (LHNs) and will improve frontline service delivery by working to integrate the primary, community and secondary sectors for the benefit of patients. A key focus of the PHNs will be working collaboratively with LHNs to reduce hospital admissions and re-admissions.”

For the time being, the government will target funding through Medicare Locals to address regional health priorities.

It will continue to support Healthdirect Australia and its nurse triage and after-hours GP helplines, and the National Health Services Directory (NHSD), which is also run by Healthdirect. Healthdirect’s plan to add secure messaging and telehealth addresses to the NHSD will go ahead.

The Australian Commission on Safety and Quality in Health Care – which runs an independent governance committee overseeing the PCEHR – along with the Australian Institute of Health and Welfare, the Independent Hospital Pricing Authority and the National Hospital Performance Authority, are set to be merged into one body, but this is subject to the approval of COAG.

There is no mention of ongoing funding for the National E-Health Transition Authority (NEHTA) in the budget papers. NEHTA is co-funded by COAG and its future will presumably depend on COAG’s agreement on continuing its funding or closing it down.