eMessaging gateway to GPs part of the west side story

Melbourne’s Western Health is gearing up to enter phase two of a project to securely deliver notifications from its hospital systems directly into GP desktop practice management software through an SMD-compliant eMessaging Gateway.

Western Health’s executive director of ICT, Jason Whakaari, told the eHealth Interoperability Conference in Sydney recently that the organisation had worked with secure messaging vendor HealthLink and health IT firm Alcidion to extract information from Western Health’s BOSSnet digital medical record and deliver it directly into GP desktop systems.

Western Health, which includes the Williamstown, Footscray and Sunshine hospitals, worked with its two Medicare Locals – South Western Melbourne (SWMML) and Macedon Ranges and North Western Melbourne (MRNWMML) – to hook up general practices as part of a pilot that first began in December 2013.

The ongoing project involves 22 practices comprising 162 GPs, or 20 per cent of GPs in the catchment, who are able to receive basic admissions, discharge and transfer notifications directly into their systems, as well as notifications of deceased patients and receipt of referrals. The GP systems are a mixture of predominantly MedicalDirector with some instances of Zedmed, Best Practice and Medtech.

While the majority of notifications are still going out to the other GPs in the region by fax, the project is achieving an average of 11 per cent of notifications sent electronically, with the bulk involving notifications of outpatient appointments, admissions, discharges and receipt of referral.

The next phase is to add more clinically relevant documents, including discharge summaries, outpatient summaries and medications summaries, Mr Whakaari said.

“It’s nice to have the admission, discharge and transfer information going out but from the GP feedback that we get, they say they’re interested in medication summaries more than anything else,” he said. “If they had to choose something to get quickly, they’d choose medication summaries.”

The existing pilot has been extended to include the scoping out of the next phase, which if successful will then be opened up to all GPs in the area, he said. For the less tech savvy practices, the Medicare Locals have been helping to organise all of the required digital certificates and back-end work that the hospitals aren’t keen on dealing with.

“The next component of it is that we’ll look at exploring options for managing inbound referrals from GP to the acute,” he said. “When I say look at options, it could be gateways, because currently we scan in our referrals that we receive in paper form through the fax. So we could automate that, or we could also do something where we open up our booking system so that the GPs can book [electronically], much like the UK experiment. We’re going to look at that soon after we hit phase two.”

While HealthLink was chosen as the messaging vendor for the pilot, Western Health will go out to tender again for a full roll-out if phase two is successful. Mr Whakaari said he hoped that the SMX consortium – in which the major vendors have achieved interoperability with each other but have not yet progressed into the wild – would be successful.

“What we’d love to see of course from a health service perspective is the SMX up and running,” he said. “Hopefully that’s something that gets up and we’d certainly be interested in leading the innovation charge and supporting deployment if it was something that’s got some support.”

In addition to the eMessaging Gateway, Mr Whakaari covered four other areas where Western Health is leading the way. This includes laying down an infrastructure layer to allow for mobile and remote access to systems, the move from paper to digital with the roll-out of the BOSSnet digital medical record, the development of an Intelligent Patient Journey System in association with Alcidion and the allied implementation of an Access Glance bed management system with the same vendor, and the future implementation of the Vergence patient context switching system from Caradigm.

For mobility, Western Health is using the Oracle/Sun JCAPS integration engine that is supported by Victoria’s Health Design Authority, ubiquitous WiFi in clinical and non-clinical areas, Citrix’s Access Gateway for multi-user and remote access, two-factor authentication access and bring your own device.

The organisation is also taking a close look at the potential that the recent announcement by Microsoft that it will host its Azure cloud platform onshore can offer in the future. “We’ve never considered storage on the cloud in the past because of the inability to control governance if it’s not grounded within the Australian environment, but we’re having a good look at that.” Mr Whakaari said.

“We’re actually a Microsoft shop in the sense that in Victoria, we have a state Microsoft enterprise licence. You pay an annual fee and you can use whatever software that you like within the Microsoft environment. It works really well for us and we try to take advantage of that wherever we can.”

Mr Whakaari said the most significant eHealth development for Western Health in terms of getting away from paper had been the implementation of Core Medical Solution’s BOSSnet digital medical record (DMR) scanning solution and its associated e-forms.

“What stood out for us over and above some of the other competitors when we did the tender was it had an ability to add additional functionalities,” he said. “So in addition to the scanning, we’ve got a range of e-forms; the clinicians can do direct entries into the e-forms. It can automate through HL7 direct entry from some systems that are capable in our environment and put the data straight in.

“Now we’ve progressed so that we’re producing discharge summaries and medication summaries out of that system.”

Mr Whakaari said it was fortunate that at the time of implementing the digital medical record, the organisation was also in the process of changing its pathology information system provider, meaning clinicians could do their results viewing from the new pathology provider from within the DMR.

For radiology, Western Health has a full Fujifilm suite, including an allied system called the intelligent Cardiovascular Information System (iCVIS), designed by South Australian firm Alcidion in association with Fujifilm. “I think we’re going to be the first health service in Australia to have a Fuji radiology PACS, a Fuji cardiology PACS, a Fuji radiology information system and a Fuji cardiology information system,” Mr Whakaari said.

Alcidion also designed the next innovation developed at Western Health, which is now being rolled out elsewhere – the intelligent Patient Journey System (iPJS). When added to the Access Glance bed management system also installed, clinicians and managers can all see where a patient is in both the clinical and patient flow sense.

iPJS was funded by a $1.5 million Department of Business and Innovation grant and is now live in six wards. It involves a set-up that resembles a commercial television in portrait view that hangs on the wall, alongside an iPad through which clinicians can do data entry.

“Each ward also has four iPad Mini retina display versions, which they take around the wards,” Mr Whakaari said. “If the doctor is coming in to do their rounds they’ll take the iPad with them to get some of the information.”

This information includes clinical assessments, notifications, internal referrals, queue monitoring and medication monitoring, and also tells the clinician if the patient is ready to be discharged and the planned discharge date, all in one app.

It also provides access to the iPM patient administration system from CSC, BOSSnet, the laboratory and pathology systems and the emergency department system, also from CSC.

“With the results, if you have a pathology or radiology or cardiology result, it’s got the drill down ‘tapability’ like an iPad tends to have,” he said. “So you can just tap on it and it will take you to a radiology image, for example, or pathology results. You can just drill down and drill back up, which is nice simplicity in the user front-end. That’s what clinicians really like about it.

“For their internal referrals, [it] runs a traffic light system in there as well, so if you have been referred to cardiology for some sort of test, it will have cardiology written there and it will be red, showing that they’ve got a referral booked but they haven’t been yet. If it’s got cardiology in orange, it means they’ve gone off to cardiology and if it’s cardiology in green, it means you can tap on it to drill down to check out the results that you actually need.

“They’ll have the referral and their results and when you tap down into the results there is another traffic light infrastructure that tells you if it’s in normal range, when it’ll be green. If it’s some sort of outlier that the clinician should be more concerned about, then that would tend to be red. It’s the same for all of the diagnostic referral areas – pathology, cardiology, radiology – it has that traffic light infrastructure around it.”

Alcidion built the iPJS based on its Maya platform, which also underpins the Access Glance bed management system being used to provide a view of the bed status of the entire hospital. Access Glance uses a drag-and-drop method that allows users to change bed occupancy around to assist with patient flow.

“Access Glance is very mobile,” Mr Whakaari said. “You’ll see nearly all of the clinical, executive and divisional directors walking around with the bed management views on their iPads, and the same with the bed management staff, the quality managers, the NUMs and any staff that help move the patients around.”

The final initiative that Mr Whakaari hopes to implement is patient context switching using a clinical workstation and associated software called Vergence, designed by Caradigm. In use at Macquarie University Hospital in Sydney, Vergence is able to link to a host of information systems so that once a change is made in one it flows directly into another without the data having to be re-entered.

It is a single sign-on, role-based application that allows for context management, he said.

“If you have five different screens open, for example, and you change the patient in one of the systems that you’re looking at, it will automatically change the same patient in the other screens you’ve got open. So if you’re looking at a PACS result and you change it from George to Jason, the other systems automatically filter through. We think that’s got great efficiency in clinical workflow, but it’s also got potential to reduce human error, retyping it in on the other systems.”

The system can work across as many vendor bridges as required, but Western Health is looking at five initially: patient administration, digital medical record, radiology, allied health and emergency department.

“We partly chose things that are core to our organisation and we also chose some that we know are really hard to do the development work with, so we’ll get the vendor to do those,” he said. “We might also bring on some that are less mission-critical in the future. It also includes a single sign-on solution. A lot of people have that but we don’t in our environment.”

Next stop is electronic orders for pathology and radiology. Western Health is considering whether to roll-out limited CPOE through the existing digital medical record or to wait until funding becomes available to flip to a full electronic medical record.

It had hoped to get some funding through the most recent round of the Victorian ICT Innovation Fund – the beneficiaries of which were announced shortly after Mr Whakaari’s presentation at the eHealth Interoperability Conference, with Western Health missing out – before deciding on whether to spend a smaller amount on CPOE through BOSSnet or a much larger amount on a full EMR.

“Either way we’re going to have quite a bit of board investment required if we do the flip, and if we don’t flip now, we certainly will flip at some stage in the future,” he said. “But it is a big investment and we’ve got to be realistic about that. The bigger the investment, the less likely it will get supported.”

Opinion: connected care means connected technology

The health system evolved to deal with the health problems of the day, but the needs of our population have changed dramatically in the last 40 years.

New models of person-centred, connected care are an emerging response to a health system struggling to cope with larger numbers of elderly and people with chronic illnesses.

The idea of ‘connected care’ aims to make it easier for all involved in a person’s health and social service support to act as a team. It’s about better decision-making and empowering greater self-care, built around a single, shared care plan.

Although intuitive, providing connected care presents a major change for many health ‘ecosystems’ and their funders, providers and patients. Technology plays a crucial enabling role but is only one element to be considered in the overall change management process.

At Canterbury District Health Board (DHB) in New Zealand, a whole of system approach to integrated care incorporates a shared care management platform to support a range of targeted initiatives, each dealing with a different set of specific but often overlapping patient needs.

These programs include a multidisciplinary community-based rehabilitative supported discharge program for elderly patients, a medicines management service for patients with high needs, an advance care plan, an acute plan to support the prevention of unnecessary acute admissions and ‘generic’ care coordination.

Since the patients in each program often overlap, having a common platform is invaluable. In this instance, Canterbury DHB is using HSAGlobal’s Collaborative Care Management Solution (CCMS).

The Community Rehabilitation Enablement Support Team (CREST) program uses a funding model based on an alliance arrangement between the care providers and the funder. Care is funded for a team delivering the service and health outcomes, not for individual outputs.

Each patient has a team of providers surrounding them, coordinating their care, and keeping them out of hospital. The coordinated approach minimises errors and improves communication when care plans change. Data from CCMS is used to support a quality improvement process across all care providers involved and is critical to improving patient outcomes.

CREST was introduced in April 2011 and more than 1700 patients were kept out of hospital in the first year of the program. Since then, over 4000 people have had their hospital length of stay reduced by management in the program without a subsequent increase in readmission rates.

Achieving this sort of joined up care and support within one health ‘economy’ requires multiple enabling information systems to play their part. In Canterbury, this includes Health Pathways, the electronic Shared Care Record View (eSCRV) portal designed by Orion Health and rolled out by Health Connect South, an electronic referral management system (ERMS) and CCMS. At the same time, ‘whole of system’ processes must be agreed for access, auditing and privacy.

Another large scale, connected care program linking health and social service providers is the ‘At Risk Individuals’ (ARI) program at Counties-Manukau DHB, which focuses on a stratified population of individuals at higher risk of hospitalisation.

ARI will support up to 30,000 at risk people with a CCMS-based care plan by the end of 2015 – one of the largest integrated care programs in the world. Once enrolled by their GP, a designated care coordinator will work with each person to co-develop a team-care plan and monitor progress and follow-up actions, working securely with other service providers within the single care plan.

A summary health record, available through Orion’s Concerto patient record software, means key patient information is visible to everyone involved in their care even if they are not a regular member of the care team.

Again, delivering the vision for ARI requires integration of multiple hospital and primary care systems, including CCMS, Concerto and GP desktop systems such as Medtech and MyPractice, as well as systems connecting pharmacies, hospices and community providers.

At the ‘back-end’ delivery side of the solution, information standards like GP2GP are essential to guide integration, while licensing models that encourage sharing and prevent silos are also critical.

A population-based license is used for CCMS, removing any funding obstacles to the DHB adopting the care platform for as many programs and patients as possible with the goal of arriving at a ‘whole of patient’ view over time.

One way of effectively introducing connected care is to establish a simple starting point for a wide base of users and then layer more specialised programs on top for those that are ready. Connected care can be implemented incrementally, allowing funders and providers to start with small, simple improvements, taking advantage of new opportunities as experience and skills allow.

Different ‘flavours’ of shared care plans have emerged to reflect these different starting points, such as advance care plans, acute plans, meds adherence, service coordination and team-based plans.

Consumer engagement is critical throughout the design and delivery of connected care. Consumers are both contributors to and beneficiaries of joined up care. Each individual success story helps build confidence in new ways of delivering health and social services and contributes to the growing evidence that connected care works.

Significant lessons are also emerging about the role of funding – potentially a motivator or a barrier – in ensuring program sustainability. Contracting models are evolving as funders and providers build trust and experience.

Connecting care is a complex task with a number of dimensions to consider and manage. Experience in New Zealand does suggest though that sustainable change is possible and does deliver.

Matt Hector-Taylor is the managing director of HSAGlobal.

Opinion: Are you prepared for e-disclosure?

Whether known as disclosure in the UK and Australia or discovery in the US, the process is identical, referring to a situation where evidence is shared between parties to a lawsuit before the actual trial begins.

In an internet age, a new process is necessary to perform disclosure tasks for digital information that is stored in many locations (back-ups or on the cloud, for example) or involve multiple formats or recipients.

Cue the rise of e-disclosure into a billion-dollar industry, where digital information such as emails, chat messages, medical records and other documents are presented for review in a human-readable format.

Why should we care? Unfortunately, if a practice is requested to provide data relevant to a court case, even if not directly involved, it must be produced. In such a case, the costs involved in mining data are often substantial, sometimes in the region of hundreds of thousands of dollars for complex requests.

Luckily, unlike the US, Australians have the opportunity to estimate the costs for recovering data and can avoid data forensics if the costs outweigh the benefits to the case. The Federal Court of Australia also explains the use of electronic technology in litigation according to Australian law and is a useful reference.

While there is no mandatory requirement for data retention in Australia, many of us are reluctant to discard data that may be useful in the future and most clinics have an archiving or back-up process in place. Some allow employee access on portable devices such as smartphones and laptops.

(Whilst the Privacy Act does not specify a mandatory requirement for data retention but rather focuses on the security and protection of data, health organisations and clinics must not confuse this with the Health Records & Information Privacy Act, where there is a requirement for the retention of health records for a set period of time.)

It is worth noting that under e-disclosure, each instance of a document is required, regardless of location, and reasonable steps are taken to ensure all copies are available. Failure to do so can result in substantial damages that can bankrupt an organisation if the costs to recover data are seen as ‘reasonable’ by the court.

But what makes the process so expensive? Surely, retrieving records or documents is an easy task in this day and age?

The reason is that specific information is necessary and data retrieval is carried out by data forensics specialists, in a manner that retrieves the document with all metadata (hidden data that shows additional information such as the date the document was created, document owner and more). Specific requirements for data retrieval are defined in the pre-trial stage and will determine the actual costs involved.

Clinics and medical practices can protect themselves and reduce the time taken to produce data by taking an approach to data management that satisfies all requirements, whether legislative compliance, security of information or production of records for litigation purposes. The IT cost of data retention can escalate if not managed correctly.

In a traditional situation, businesses deal with:

The primary problem is that businesses often fail to link these disparate copies correctly and additional copies are often created inadvertently, as different revisions are created or email updates are sent. Information lifecycle management (ILM) is the ultimate aim, where each document is tracked from initial conception, through multiple revisions and to eventual purge and deletion.

Happily, there are software solutions that will handle these issues and ensure that compliance, e-disclosure and other data tasks are handled in the background without manual intervention. These solutions are customised to suit the activities of the practice.

Making the transition to electronic document management sooner rather than later is recommended, as it is much easier to work with electronic originals rather than handle conversions from paper-based records. Integrating radiology media and other image-based data is an added advantage.

It is also worthwhile reducing data volumes by purging unnecessary data in a secure manner. Staff training is essential and original data should be accessed from a single central location, without sending copies by email or other method, instead sending links that allow authorised users to view the data.

The fact remains that every business, regardless of size, faces a risk of exposure to such a situation. Preparation is key. Effective data management and careful control of data access will substantially reduce the costs associated with unexpected litigation or demands for data.

This can be achieved by use of cloud-based solutions, for example, as data is stored in a single location and accessed remotely by employees with the correct user credentials. This is an important consideration when sensitive information such as health records is involved.

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

The end of the paper drug chart

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

Implementing an electronic medications management system is a hugely complex and difficult project for the acute care sector, but one where the benefits are most quickly realised through reductions in medications misadventure. In these case studies, we look at how eMM has been rolled out at private not-for-profit Cabrini Health, tertiary facility Austin Health, outer-metropolitan Peninsula Health, and the rural Portland Hospital.

Acute care software specialist InterSystems recently conducted an ad hoc survey of 30 Australian hospitals that are currently deploying or are planning to implement electronic medication management (eMM) systems to see how they are faring.

Most cited complexity and interoperability requirements as significant barriers to eMM implementations, with 26 public hospitals and four private hospitals reporting that while they all expected eMM to lead to increased patient safety, 60 per cent cited complexity or cost of interoperability as a significant barrier to deployment.

When asked how many other systems eMM would need to interoperate with, 47 per cent of hospitals said five to 10 systems and 20 per cent said 15-20, with the average number around 12.

Change management issues and difficulty in gaining clinical adoption were cited by about half of respondents as barriers, but most believed it was worth it.

Full details of these case studies are available online: Cabrini and Medchart, Portland Hospital and TrakCare, Austin/Peninsula and Cerner.

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

Renal telemedicine: a registrar’s experience

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

Earlier this year, the Northern Territory’s specialist training program funded a new service providing renal telemedicine consultations by registrars from Royal Darwin Hospital. The service’s registrar reflects on the benefits of the service as well as the unique challenges that have to be overcome in the Top End.

In the Top End, we face unique challenges in terms of delivering renal services to our population, which is spread out into small communities. The burden of kidney disease is relatively high and we have established a successful outreach program, but despite 98 visits a year to different communities by four full-time nephrologists, there was still room for improvement.

From February this year, the specialist training program funded a renal advanced trainee position dedicated to telemedicine. Four registrars would rotate into this position in 2014, and I was the first renal telemedicine registrar at Royal Darwin Hospital. So far, we have yet to encounter other sites with a similar role, but we believe creating similar positions would be beneficial for the hospital’s telemedicine program and its patients, as well as providing unique learning opportunities for the registrars.

Having a dedicated telemedicine medical professional is useful when setting up and running telehealth clinics. As the first telemedicine registrar, I helped to design the telemedicine program with the careful guidance of my consultants. We were able to set up specialised telehealth areas in our organisation and dedicated a consulting room in the dialysis unit to telehealth.

Given there was a dedicated registrar, we were able to provide up to three telehealth clinics a week in the form of provider-to-patient and also provider-to-provider tele-consults. One of these clinics is run by both the chronic kidney disease nurse and the telemedicine registrar. We do not have any restrictions in terms of the characteristics of patients to be reviewed through telemedicine.

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

Patients First set to release PMS review round two

New Zealand’s not-for-profit health IT organisation Patients First is getting ready to release the first of four reports in round two of its practice management system (PMS) review, focusing on the capabilities and potential for patient portals in line with the NZ National Health IT Board’s roadmap.

Patients First is also set to release an updated version of the GP2GP electronic transfer of notes system, which will allow practices to transfer and receive far larger file sizes directly into their PMSs.

The company is also set to farewell founding CEO Andrew Terris after more than four years in the role. Mr Terris is taking a sabbatical in early July and will be replaced by Jayden MacRae, formerly director of research and tech innovation with Wellington-based primary health organisation Compass Health.

Patients First published the original version of its PMS review in 2012, which investigated and scored the capabilities of the four main primary care PMS vendors – Medtech, Houston Medical, Intrahealth and myPractice.

For the second round of the review, Patients First has taken a different tack and will focus on four main areas, only one of which will be scored.

“There’s quite a lot of learning that we took out of the first review and that was applied to the second one,” Mr Terris said. “What we’ve elected to do in this review is rather than produce a large report, we are going to be releasing it in sections, like a series of briefing papers.

“Whereas the last review focused on some specific areas that we scored, what we’ve agreed with this review is that some of the areas are pretty nascent in terms of the technology or expertise in New Zealand, so rather than have a full scored report for all of the areas, we are actually treating this more as an educational resource for the sector.”

The four areas are patient portals, hosting in the cloud, support and prescribing, with only the latter receiving a score in comparison to the other PMSs. Mr Terris said the portal report will hopefully be released in early July, with the cloud report to come several weeks after that. Prescribing and support are due later in the year.

The choice of portals for the first paper was driven by the emphasis that is being placed on offering all patients a portal to view their medical records by the National Health IT Board, Mr Terris said. Some estimates put GP provision of a portal at about 20 per cent of all practices in the country.

“When we set out on this journey for the second review about 14 months ago, we said we would like the review to focus on some specific questions and reflections from the expert panel, and rather than scoring the capability of each of the portal offerings we’d rather … publish the results as a Q&A in a document and then put some commentary on the front end of that,” Mr Terris said.

“That commentary includes what are some of the reflections from the expert panel in terms of how to convince [practices] that portals would be useful to adopt and in what circumstances, and some of the enablers and barriers to doing that.”

The report is currently in draft form and is with the four vendors at the moment to check for accuracy. Mr Terris said Patients First had also contracted well-known health IT expert Sue Wells, who completed a Harkness Fellowship at Harvard University on patient portals, to help frame the report.

“We also went back to some consumers, borrowing from the National Health IT Board’s consumer group, and asked them to provide not their comments on the report itself but a separate annexe to the report about consumer reflections on portals,” he said.

“We think it will end up as a pretty well-rounded briefing document for the sector showing here is what some of our clinical colleagues’ questions and comments are, here’s what the vendors offerings are and what they have to say about it, and here is what the consumers think. We are also going to offer it to the National Health IT Board for the opportunity for their comment.”

Mr Terris said three of the PMS vendors currently offer a portal, including Medtech’s ManageMyHealth, myPractice and Intrahealth. Houston Medical managing director Derek Gower said his company was working with Medtech to integrate ManageMyHealth into the Houston system.

In addition to the primary care PMS vendors, portals are increasingly used in community care in New Zealand, including Orion Health’s offerings such as that used in the Canterbury eSCRV project and Auckland’s connected care portal using HSAGlobal’s CCMS. Mr Terris said that while the scope of the review was predominantly around PMSs, there is also a brief view on the broader application of patient portals.

Both Mr Terris and Mr MacRae said it was unclear whether the first review, which did rank the PMSs, had led to any changes in purchasing decisions, but it was certainly a discussion point.

“My observation is that some of the issues highlighted in the first review have been brought to the attention of the vendors,” Mr MacRae said. “We’ve certainly witnessed over the last couple of years that some of those issues around interoperability and security have been improved by the vendors.

“I also think it’s had an influence on their behaviour and their priorities, which has been a really positive outcome for everyone.”

The other three areas of hosting in the cloud, prescribing and support will also be released as separate reports. Mr Terris said the cloud paper would be similar to the one on portals in that cloud is still a nascent technology in New Zealand’s primary care sector.

“There’s really not much expertise in the health environment in New Zealand to be able to make a judgement call on the capability of the vendors,” he said. “So what we’ve done is ask the vendors about their architectural approach and capability for their systems … about how well they’ve geared or architected their products for a cloud environment.

“The second briefing paper probably won’t be a lengthy paper and it will try to talk in relatively practical terms rather than technical terms, so it will translate or demystify what cloud means. Most of the vendors responded to that more from a hosting lens rather than a cloud lens.

“We will try to use some metaphors like the accounting software Xero and Google Docs and also describe the differences in functionality between a desktop app and a hosted in the cloud app. We don’t have a timeframe around that one but would like to think it will come out about two to three weeks after the portal paper.”

The prescribing paper will be scored, predominantly on clinical and safety and quality standards rather than technical. Mr Terris said there were about 30 or 40 questions included that have been sent to the vendors and which will be gathered together under five key themes in the resulting report.

The final paper will be on support for users. Patients First hopes to survey a large population of GPs and practice managers about their thoughts on the support offered by their vendors. This will require more work so a publication date has not yet been decided, Mr Terris said.

What the company hopes to do is add the information gained in these reviews to its plans for a national certification system for medical software. Patients First has already built an integration platform through which vendors can test their products against certain technical standards.

The idea is to ensure that there is an independent way to assess vendor offerings and offer guidance to vendors on how to comply.

“One of the original criticisms that was levelled at us – and it was probably fair – was that the first review was quite subjective and not that objective,” Mr Terris said. “It was probably 70 to 80 per cent subjective and 20 per cent objective, and the goal is basically to invert that ratio.

“We still see a need for a clinical expert group of users to be able to make comments on the various PMSs’ usability, but we want to balance that out with … published standards that PMSs should be complying with. That will provide a very easy way for purchasers and the user community to look online and see that if they are choosing this product, how do they know it is actually compliant with the standards.

“Rather than just asking them ‘do you comply’, we want to be able to look at it independently and be able to say these vendors have tested themselves against these standards and they either comply or they don’t.”

Clinicians’ Challenge winner launches clinical translation app

The winning entry in the 2011 Clinicians’ Challenge has been officially released after several years of development, resulting in an app that can be used by patients with speech difficulties or English as a second language to communicate with clinicians, and vice versa.

Listen Please was first put forward in the 2011 competition, which is organised by HINZ, the New Zealand Health IT Cluster and the National Health IT Board, and has since been refined by inventor Janet Liang.

Dr Liang, an intensive care specialist at North Shore Hospital in Takapuna, developed the app for use in medical emergencies and at the bedside. It is primarily aimed at patients who can’t speak at all due to airway restrictions or for patients who don’t speak English.

It can translate Mandarin, Cantonese, Korean, Samoan and Tongan through printed and audio translations and uses pictures and photos to help understanding. The idea is to use the app in emergency situations when a human translator is not available.

“The app has been created out of my own professional observations about how we can better communicate with patients who don’t understand a lot of English, and for them to communicate with us more clearly when they cannot speak English or can’t speak at all,” Dr Liang said in a statement.

“Clinical translators do a fantastic job, but it sometimes isn’t practical to have one around all day, or sometimes they cannot be available quickly enough.

“The app allows for clinicians to ask simple questions that would be covered in a standard consultation, such as ‘Are you in any pain?’ or ‘Where do you feel pain?’, while patients can also communicate with medical staff, for example, if they we wanted to speak to family members or to go to the toilet.”

Dr Liang has devised a series of questions that clinicians would need to ask in an emergency as well as those that can be asked during everyday care. The questions are worded to suggest Yes (tick)/ No (cross)/ Don’t Know (question mark) answers so that clinicians don’t need to translate the patient’s reply.

There is also a patient talks mode to allow patients to communicate common needs such as wanting to speak to family or to go to the toilet. The clinician asks mode allows users to take a basic history or perform an examination.

Dr Liang has used the prize money from the Clinicians’ Challenge as well as a grant from Waitemata DHB and her own funds to create the app. She plans to use the proceeds of sales to further develop the app and add more translated statements and languages.

Southern DHB plans to extend telehealth links

A trial of telemedicine that allows rehabilitation specialists in Dunedin to hold clinics by video conference with Southland Hospital has proved successful, according to Southern DHB.

The trial has been going since the start of the year and links the ISIS rehabilitation ward at Wakari Hospital to the Assessment Treatment and Rehabilitation (ATR) team at Southland Hospital.

The link is predominantly for family meetings, multi-disciplinary team meetings and education and training.

Southern DHB has been installing more video links into the outpatient clinic rooms at Lakes District Hospital and Balclutha Hospital which can be used by consultants to video conference with other clinicians as well as to see patients remotely.

The DHB will next trial dietetic appointments for Lakes patients via video link into Southland Hospital.

Telemedicine is the way forward for a district this size, Southern DHB executive director of patient services, Lexie O’Shea, said.

“This enables more patient better access to healthcare, and providing health services remotely can reduce hospitalisations and save patients travel,” Ms O’Shea said.

CPR app with chest compression time assist

New Zealand’s St John ambulance and emergency service has released a new CPR app that features a beeping and vibrating assistance function to help time consistent chest compressions.

The free app is aimed at the general public and includes simple, user-friendly instructions as well as tutorials on CPR for adults, children and infants.

The app is optimised for iPhone, Android and Windows phones and can also be installed on iPads, although not all features are supported on the tablet.

Instructions can be spoken aloud from the app on Windows phones and pin shortcuts to the different CPR techniques on the home screen.

“CPR is simple to do but in the heat of the moment it’s easy for your mind to go blank and that’s where this app will be a vital prompt and guide,” St John’s medical director, Tony Smith, said.

In addition to the CPR Timing Assist function, users can set up their own emergency services phone number when overseas.

Technology, self-management and chronic disease models of care

The New Zealand Long-Term Conditions Clinical Network and the Health Navigator Charitable are co-hosting the second Australasian Long-Term Conditions conference in Auckland in late July, which will have an emphasis on developing new models of care for people and communities with chronic illness.

Keynote speakers include futurist Ross Dawson, who will discuss the future of healthcare in the context of the changing pace of health technologies; Sue Wells, a former GP and senior lecturer at the University of Auckland with a research interest in eHealth initiatives, patient engagement and interaction with health services via patient portals; and mobile health specialist Robyn Whittaker, program leader in health informatics and technology at the National Institute for Health Innovation.

Dr Wells and Dr Whittaker will take part in a new paradigms for health and healthcare session on the first day of the conference. Dr Wells will be joined by the CEO of the National Health IT Board, Graeme Osborne, in a discussion on patient portals, while Dr Whittaker will discuss mobile technologies using diabetes and smoking cessation apps as examples.

The conference, entitled ‘Health – the art of the possible’, will also look at integrated care, positive ageing, patient self-management and and strategies for living well with long-term conditions.

It will be held at the Waipuna Hotel and Conference Centre in Auckland on July 29 and 30.