Holiday reading: Aged Care ICT & eHealth

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

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

Frustration grows for aged care, the forgotten child of eHealth

The aged care sector is frustrated at its position as the “forgotten child” of the national PCEHR roll-out and has called on the government to provide clarity over the central client record due to launch next year as part of the Aged Care Gateway.

CEO of Leading Age Services Australia (LASA) Patrick Reid has echoed concerns raised by other aged care sector experts over the development of the central client record, the design of which appears to have deviated from the original plan to either be linked to or be part of the PCEHR.

While the Department of Social Services (DSS) says there are plans to link the record – which will be assigned to every person accessing aged care services from July 1 next year – to the PCEHR some time in future, many in the sector are still convinced that the PCEHR itself should be the single record, having been designed to allow non-clinical information to be added.

The idea of two separate records rather than one that follows the individual through life and different care settings fills many in the sector with dread, and according to Mr Reid, has the strong potential to fail.

Mr Reid also expressed the sector’s frustration at the support provided to other parts of the health system, such as the funding announced this week for private hospitals and the grants provided to GPs and pharmacists for equipment, at what could be seen as the expense of aged care, where the PCEHR might have the most value.

“Nobody is going to come to aged care as a neophyte in our health system,” he said. “For me it’s a no-brainer when you are looking at a million-plus Australians receiving care in the aged care system.

“We’re also one of the frequent flyers in terms of hospital admissions and transition care, so within that I guess we are a little bit frustrated to see these other groups getting money or getting support or getting change management assistance. Meanwhile we limp along, doing what we do.”

Mr Reid pointed out that of the four key priority areas for the PCEHR – mothers and babies, indigenous people, those with chronic illnesses and older people – aged care covered two: chronic disease and older Australians.

“And yet, we seem to be the forgotten children in terms of the preparation for PCEHR,” he said. “In terms of getting ready for PCEHR and the change management required to move aged care into this sphere, and this across not just residential but community and retirement, it’s a forgotten child.”

Mr Reid, who is a qualified pharmacist with several IT credentials and who worked with the Pharmacy Guild in a number of roles, including four years as national manager for business development, IT and eHealth, said there were real dangers in developing two records that did not work together.

“Historically, with any IT program, and it doesn’t just apply to health, if you have two records that have to remain in sync, it’s pretty hard to do and normally ends in failure. So the holy grail, the endpoint, should be one record.

“Nobody is coming into aged care without having been in the health system previously. Many of these people will have had some contact and intersection with the PCEHR before they reach aged care, so it makes sense that you would either build out that existing record if it is not sufficient or you would use that record to move forward.

“The problem I have in looking at the architecture of phase one and phase two of the Gateway, is that the architecture has been set without the PCEHR in mind, because it was sort of developed during that hiatus with the PCEHR, that post-election period. So to say that there could be two that are linked, I think that’s fraught with concern and problems.

“One record is preferable, and in fact if we don’t have one we’ll just end up chasing our tails in the future.”

At a time when every bean is being counted, the large amount of funding required to implement the PCEHR and the central client record across residential and community aged care could be a stumbling block, but Mr Reid argues that this consideration is a false economy.

“The longer it takes to integrate aged care the more it will cost them in terms of hospital admissions, in terms of transitions,” he said. “For many people, the last few years of their life are when they are intensive users of acute and sub-acute care, so any reluctance to fund this process is really just delaying the inevitable, but also too it’s a false economy.

“The sooner they get this thing in the sooner they are going to find areas of duplication, areas of streamlining but also too minimising errors, minimising adverse outcomes. In terms of that argument I think it’s a false economy and they’ll realise they should have done it sooner.”

Many in the sector argue that the roll-out of the PCEHR should have started with aged care rather than general practice, but Mr Reid believes it should actually have involved pharmacy first to ensure medications management was the priority.

“Medication management should have been done first and pharmacy was best placed to pick up and run with the IT,” he said. “The second port of call should have been aged care.

“In terms of the outcomes, there was a lot of low-hanging fruit. We were told there was low-hanging fruit in both medication management and aged care; in fact to roll up medication management into aged care is an absolutely a no-brainer.

“They should have done that, but they still persisted with this holy grail approach of we are going to do everything at once and the GPs are going to be the gatekeeper. This fixation with GPs as the gatekeeper … it’s rare that you get someone holding the key saying that they don’t want to own the door.”

With consumer-directed care (CDC) now set to begin in earnest and demand for community and residential aged care set to increase, Mr Reid said it was imperative that the electronic systems envisioned to handle this demand were in place.

“Figures show that most people live disability-free until about 62 years. We have 1000 people turning 65 per week in Australia, they are all over that median when complex intervention is required, so this means they need a record and they need it now. It’s as simple as that.”

Life story on an iPad for people with dementia

A Perth-based occupational therapist has developed a new app for people with dementia that can record their life stories and be used as a tool to guide person-centred care.

The My Life Story app allows users to create a photo slideshow accompanied by music and voice recordings and loaded onto touchscreen devices like the iPad.

Creator Genevieve Major said it was not only aimed at promoting positive experiences and feelings of wellbeing for people with dementia, but also for carers and nurses as a reminiscing tool when the person enters residential aged care.

Ms Major said the use of stories and reminiscing to improve mood was well researched and widely used by occupational and other therapists, but it was under-utilised in institutional care.

She said there were two main inspirations behind developing the app, which she has developed in association with Perth design agency Gramercy Studios.

“One was I started to see lots of research about how music engages the minds of people with dementia, and at the same time there was a study from the University of Worcester in the UK on the benefits of touchscreen technology for people with dementia,” she said.

“The two ideas came together and I thought if we could be more engaged with the younger generation because of the touchscreen technology, and then include more engaging things like music and voice recordings and life stories, that would be awesome.”

The app works by bringing together a slideshow of photos that can be captioned along with music, text and voice recordings, which Ms Major said were often used with people with dementia.

“Depending on the level of the person with dementia, you can choose to have all of those things, none of those things, just the photos and the music, or just text if they can still read,” she said.

“Once it is set up it plays as a slideshow. It is all pre-set, so all the person with dementia needs to do is press play, and then it plays through. You can change how long you want each slide to stay on for, but that is all pre-set, so the person with dementia doesn’t have to worry about fiddling around with buttons. If the person is capable they can pause it and go back, but for the most part it will just play through.”

Ms Major said the app can be used as a useful tool when a person first enters residential aged care in that not only do nurses and other staff get to know the person, but as a conversation starter for regular carers.

“When the person first goes in the family can bring it to the initial admission meeting, but then what we have been finding is that the managers or the nurses are using it in handover for the first week or so of the new person being there,” she said.

“They can just play it so everyone gets to know the person. Then once the person is settled in, it can be used as a reminiscing tool or as a one-to-one conversation starter. Carers often find it difficult to think of something to talk about with the person because they see them every day, so that is how the wellbeing comes into it.

“The research has shown that if the person with dementia has a positive emotional experience, they will keep feeling positive even after they have forgotten why they feel positive. It is that emotional hangover in that you can create positive wellbeing [on an ongoing basis] from using tools like this.”

It can also help nurses and carers in developing strong relationships with the person with dementia, she said. “Once you get to know a person, then the way you care for them and treat them is completely different.”

The My Life Story app is available on the iTunes store for $9.99. Ms Major is marketing it through word of mouth and her networks of dementia care service providers, memory clinics, community centres and nursing homes.

Alcidion partners with Fujifilm for cardiovascular care

Adelaide-based health informatics and technology specialist Alcidion is set to deploy the new intelligent Cardiovascular Information System (iCVIS) it has developed in association with Fujifilm Medical Systems in full operational mode at Melbourne’s Western Health at the end of September.

iCVIS, which was the overall winner in the health category at the iAwards earlier this month, is based on Alcidion’s Miya health informatics platform, which forms the basis for a number of clinical and patient management applications used at Western Health as well as by the departments of health in the Northern Territory and Tasmania.

Miya is the brainchild of Malcolm Pradhan, an adjunct professor in health informatics at the University of South Australia, and Ray Blight, former CEO and chairman of the South Australian Health Commission.

The company’s technology is being used to build advance care planning capabilities for aged care providers in Tasmania as part of the PCEHR roll-out and provides the foundation for an intelligent patient journey system presently deployed at Western Health. Called Miya Patient Flow, it will also be rolled out at the Royal Darwin and Alice Springs hospitals this financial year.

iCVIS, which Alcidion and Fujifilm have been developing over the last 18 months, has recently passed user acceptance testing (UAT) and is about to go into full operation at Western Health’s cardiology department, Mr Blight said. Fujifilm came up with the concept of the new system, and after a search for technology partners, chose Miya as the underlying platform.

Mr Blight, who co-founded Alcidion with Professor Pradhan in 2000, said Miya has been designed as a health informatics platform that is able to extract information about a particular patient and highlight their clinical risk factors in order to provide real-time clinical decision support – what many in the health IT sector consider the nirvana of healthcare technology.

“The Miya platform is about helping the clinician understand a patient’s clinical risk so they can make the best possible decisions,” Mr Blight said. “We are able to gather expert knowledge about a particular condition and present that in the context of a specific patient, so the decision-maker can execute the treatment in the best manner.

“It has been designed to gather the relevant data to highlight clinical risks, not the extraneous data. We can then present the medical and clinical risk data and provide relevant guidance as to the best care options. The clinician still makes the decision, but once they have done so Miya can track the implementation of the decision.”

One of Miya’s main differences is it can extract data from any clinical, administrative or logistics system in a hospital, including point-of-care devices, and marshal that data in a way that makes sense in terms of mitigating the patient’s clinical risk, he said.

“For example, if the patient has been admitted with chest pain, there’s no point presenting the data that you might have had from a previous episode which had nothing to do with cardiology. If the patient was in for a broken leg, then much of that information may not be relevant for the patient’s current clinical risk.

“Miya harvests the data and then prompts the best practice clinical protocols for chest pain to remind the clinician of all the different parameters that they need to consider, and then records the decision made, such as whether this patient has got to go off for an ECG for example. It then monitors the fact that an ECG actually gets booked, actually gets carried out and makes the results of the ECG available to all members of the care team.

“So, we’ve set off to build this monolithic platform that can support any healthcare problem resolution, regardless of which medical or surgical discipline is caring for the patient.”

iCVIS has a cardiology-specific electronic medical record that also includes logistic information as well as clinical risk factors for that particular patient, all in one system and available to the clinician instantly. This includes information on when they are booked for an intervention such as catheterisation, but will display to the clinician that the patient hasn’t completed their fasting period, meaning not only are their risk factors apparent but also saving precious resources in having to cancel or delay interventions.

Alcidion has also built a series of clinician dashboards that highlight these critical issues in the cardiac lab and ward, Mr Blight said. “It’s essentially a bespoke application of the Miya platform to the clinical risk, workflow and logistic issues that are encountered in every cardiology lab.

“The idea is that you treat the most urgent patient who’s ready for the treatment first and the team doesn’t get distracted by doing unnecessary work, or doing work at the wrong time, or doing work in a sub-optimal sequence. The idea is that this is going to save the cardiology lab a huge amount of professional time, but really the pay-off is that the patient services are safer and the patient is processed in the optimum time.”

Another point of difference for the Miya platform is that it is able to interoperate with patient administration systems such as CSC’s i.Patient Manager, commonly used in Victorian hospitals, but also with radiology, imaging, pharmacy and pathology systems.

“At Western Health, they have the Fujifilm product set, so that’s been straight forward,” Mr Blight said. “We have to integrate with the pathology system, which we’ve done, and usually we integrate with the pharmacy system for discharge meds when the patient’s ready to leave the cardiology ward.

“It is part of the Alcidion technology set to have the integration tools to do those connections, but we also have a medical terminology service, so that when we are bringing data in from other systems, we can map them to SNOMED-CT and therefore ensure that the informatics systems are not introducing any clinical risks.”

Expansion plans

While Alcidion has been around for over a decade, it has often flown under the radar in the health IT sector. With iCVIS, that is probably about to change. Another change is a new member of the board of the company, Perth-based technology entrepreneur Nathan Buzza.

Mr Buzza, who joined the company last month and is also playing an active marketing and communications role, is best known for his time at Commtech Wireless, which developed clinical alert notification middleware. Commtech’s technology has been deployed at over 8000 locations around the world, Mr Buzza said, and in 2008 was acquired by Amcom Software. In 2011, Amcom Software itself was acquired by Spok.

Mr Buzza stayed on at Amcom for 18 months as general manager before moving back to Australia, where he set up private equity firm Allure Capital. This firm then became the second largest shareholder of publicly listed Azure Healthcare, a nurse call and clinical workflow company that owns both the Austco and Sedco nurse call brands.

Mr Buzza then took his time to look out for another healthcare technology firm to invest in. After reviewing dozens of businesses, Alcidion was one company that really stood out from the crowd, he said.

“After spending the past 25 years in healthcare technology, you see lots of technologies being deployed which are either poorly implemented or don’t quite hit the mark,” he said. “One of the greatest challenges in healthcare is providing a high quality of interoperability with the myriad of clinical systems that are installed throughout the global healthcare ecosystem, and that’s what Alcidion has done exceptionally well with the Miya platform.

“It’s consolidating all of those data sources, selectively processing the highest quality and most clinically appropriate data, and when parts are missing from those sources, matching them together to provide an extremely high quality electronic health record and then passing it through to the clinical decision support engine.”

With Mr Buzza on-board and the iCVIS project now complete and rolled out, Alcidion is looking at further expansion. Mr Blight said one of the benefits of working with Fujifilm is that it is not only the dominant national player in cardiovascular radiology systems, but that it counts about 75 per cent of Australian hospitals as its customers.

As part of the partnership, Fujifilm gets the benefit of being able to offer cutting-edge technology to its customers without having to build the technology itself, while companies like Alcidion can leverage Fujifilm’s large domestic market and global reach to bring Alcidion’s technology to the world, Mr Blight said.

Back home, Alcidion is continuing its work with three major clients – Western Health, NT Health and the Tasmanian Department of Health and Human Services. For the latter, in addition to the advance care planning technology it is providing as part of the Cradle Coast PCEHR project, the department has also contracted Alcidion to deliver Miya Patient Flow, as well as an integrated outpatient system.

For Western Health, Alcidion has used a Victorian government innovation grant to develop the intelligent patient journey system (iIPJS) that is being used at Footscray, Sunshine and Williamstown hospitals.

“Halfway through that proof of concept project, we had made such great progress that the Victorian government decided that we didn’t need to innovate any further and what we should do is turn it into a production system,” Mr Blight said.

“Again Western Health was the pilot site, and we’ve now got running a patient journey system that provides any doctor or clinical team member with a complete clinical view of any of their patients, with particular attention being paid to their clinical risk factors and any service barriers that are holding up the completion of services for that patient.”

The system is now being deployed in every ward in Western Health’s three acute hospitals, with three modes of clinician dashboard involved.

“We’ve got a desktop view, which is most commonly used at the nurse work station or ward work station, but we’ve also got a very large display panel view which is excellent for clinical handover where you might have half a dozen members of the care team standing around, reviewing patients one by one,” Mr Blight said.

“It can also be accessed directly from iPad Minis so that any clinician can go to the bedside, review the patient at the bedside, record their actions, record their decisions, and by early next year they will then be able to place orders for pathology and radiology over those mobile devices, direct from the bedside.”

Mr Blight said the proof of concept finished on June 30 and the company was now implementing it across the three Western Health hospitals. It has since received an order from NT Health to deploy the intelligent journey system through the Royal Darwin and Alice Springs hospitals in the next financial year.

Protecting the information in your practice

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

A paperless medical practice is nirvana in terms of efficiency and many practices are now moving to the cloud for certain functions or for the full monty. While there is still some resistance to cloud-based services due to security fears, in reality the cloud wins hands-down. There is no room for complacency, however, so here’s what you should look out for to protect your – and your patients’ – information.

In terms of information technology, a medical practice can be characterised as a micro enterprise business with medium enterprise needs.

Almost every medical practice is a micro business in terms of size – a server, a handful of computers, printers and a few other bits and bobs. However, medical practices are medium enterprises in every other respect: compliance with stringent privacy laws, eHealth, telehealth, electronic medical records, back-up and disaster recovery, pathology and radiology downloads – the list goes on.

And therein lies the problem. At what point in time does the practice realise that almost every single transaction, both internal and external, is important? And what tools are OK to use without hampering the regular functioning of the practice?

As widely publicised and documented, the updated privacy laws came into effect on March 12 this year. The Office of the Australian Information Commissioner, which includes the office of the Privacy Commissioner, has renewed powers, the penalties are harsher and compliance with the new laws is even more critical.

The new privacy laws include the 13 Australian Privacy Principles (APPs), which apply to what is called an “APP entity”. Medical practices by their very nature in handling sensitive personal medical records qualify as an APP entity.

However, while everyone has been talking about the privacy laws, what does it mean for medical practices at the grassroots level? What is it that a practice specifically needs to do to ensure that they are compliant?

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

Queensland calls for MBS item for GP-to-patient telehealth

A Queensland parliamentary committee that has conducted an extensive inquiry into telehealth services in the state has recommended that GPs be able to bill Medicare for direct telehealth consultations with patients, and that priority be given to implementing the NBN in remote communities.

Chaired by LNP MP Trevor Ruthenberg, the committee has been holding a series of public consultations and site visits since March, following the allocation by Queensland Health Minister Lawrence Springborg in last year’s budget of $30.9 million over four years to set up a rural telehealth service.

While the committee found that Queensland Health currently has good telehealth infrastructure, it was difficult for clinicians to access, particularly on mobile devices, and was not yet providing a great deal of benefit to patients.

In addition to recommendations that the Minister for Health make representations to his federal counterpart to amend the MBS to enable GPs to bill for patient consultations, the inquiry has also recommended that the eligibility requirements in metropolitan areas be revised so that the elderly and people with a disability or in palliative care can also receive Medicare-funded telehealth services.

It also recommended that the Queensland government propose to the Commonwealth that priority be given to implementing the NBN in remote communities to provide better access to health services for Aboriginal and Torres Strait Islander peoples and other remote residents.

It also wants the Department of Health to give greater priority to improving connectivity for clinicians wanting to use the existing infrastructure through personal devices, and to consider setting up a statewide telehealth scheduling system to coordinate telehealth in the state.

While the inquiry found that Queensland has one of the largest managed telehealth networks in Australia, it also found that much of the existing infrastructure was not being put to the best use.

In his foreword to the inquiry’s report (pdf), Mr Ruthenberg made the point that although there has been significant investment in infrastructure in the past, and that infrastructure is highly regarded, the use of it for the benefit of patients remains low.

This echoes common criticisms that while most hospitals have video conferencing suites, they are often found in boardrooms and meeting rooms and are not accessible for clinical purposes. The report cites a submission from the Australasian Telehealth Society (ATS), which noted that video conference endpoints are commonly in conference or seminar rooms that are unsuitable for clinical consultations, and ad hoc clinical uses cannot be accommodated.

“The ATS argued that Queensland Health should focus telehealth expansion on incorporating video communication into routine IT systems, selecting appropriate software, and prioritising video traffic over traffic such as email and web browsing,” it says.

While Queensland Health says bandwidth across its facilities is generally very good, with 70 per cent of Queensland Health facilities connected to the state’s fibre optic networks, the report found that in the areas where telehealth is most beneficial – western Queensland and remote areas – many facilities did not have reliable internet.

“During a visit to Thursday Island the committee observed that the quality of videoconferencing to Torres Strait islands was highly variable and, in some instances, not of sufficient quality for a clinical consultation,” the report says.

“The committee noted the remoteness of some islands, the substantial improvements in health care that could be achieved if this barrier was overcome, and that the financial investment required would be significant.”

Some islands use a mixture of microwave broadband and copper links, but these are often affected by the weather. Satellite infrastructure could be explored, but the report notes that the effect of time delays can be an issue for telehealth.

“The committee suggests that the technical barriers to high quality telehealth in remote communities should be addressed with some urgency, particularly in those locations with a high proportion of Aboriginal residents and high rates of chronic disease.

“The committee recommends that the Queensland Government propose to the Commonwealth that priority be given to implementation of the National Broadband Network in remote communities to provide better access to health services for Aboriginal and Torres Strait Islander peoples and other remote residents.”

However, the report also echoes the common opinion that greater telehealth provision is not so much a technical challenge as one of coordination and workflow change management.

“With a few exceptions, technology and infrastructure are not barriers to greater use of telehealth in Queensland,” the report states. “Clinician engagement emerged as an important factor in overcoming the barriers to the greater use of telehealth.”

HCN to offer integrated online appointments in PracSoft

Health Communication Network (HCN) will offer an integrated online appointments booking module that is fully integrated into its PracSoft practice management system when it releases its planned update at the end of the year.

HCN CEO Phil Offer said the company had built the module in-house following customer feedback, but has also built an application programming interface (API) that will allow practices to continue using third-party appointment booking services if they wish.

“Obviously there are a number of [appointment booking systems] out there but customers have been saying to us for a while that they want one that is integrated into the program, particularly if they want to manage their existing customer appointments,” Mr Offer said.

“They wanted to see if they could do that from directly within PracSoft. They can still use their existing system but we’ve built a new API which will allow the other appointment aggregators to work directly with PracSoft, so the customer can manage appointments from the one user interface.”

Practices will be able to display the online appointments on their own websites, but if they don’t have one, HCN will host a web page on the practice’s behalf, which can then provide the link to patients.

Mr Offer said practices can choose which doctors’ appointments to display or to display the doctor’s name but not their appointments if they are not seeing new patients. If practices are looking for new patients, they can continue to use the other services.

“With our customers now, a lot of them do use a couple of online appointment systems, and that is why we have built the API as well,” he said. “We expect them to continue to use other services to get to new patients. We see it as a platform in that they can use whatever service they want, but we are now providing them with some more choice.”

HCN is also updating its clinical information system Medical Director in the planned summer release, which should be available at the end of the year.

Practices interested in the online booking system can pre-register on the HCN website.

Thatcher and Carroll step in temporarily at Queensland Health

Mater Health Services CIO Mal Thatcher and Queensland Health’s senior director of program delivery Paul Carroll have been appointed on a short-term basis to the roles of chief health information officer (CHIO) and chief technology officer (CTO) with the Queensland Department of Health.

Mr Thatcher will act in the new CHIO role for 12 months, beginning in September. He said Mater’s director of information solutions, Steven Parrish, would step into the CIO role in his absence.

Mr Carroll will temporarily take on the CTO role, which Queensland Health director-General Ian Maynard said was largely focused on operations and program delivery.

Mr Carroll has extensive experience in pathology and radiology information systems and was a member of NEHTA’s diagnostic services reference group.

The two new positions were created following a recommendation in Queensland Health’s 10-year ICT strategic roadmap. The CHIO position has been defined as a purely strategic one, while the CTO will be in charge of delivery.

Queensland Health’s former CIO, Ray Brown, stood down in July after five years in the position.

Queensland follows NSW in its decision to expand the CIO role into two positions. NSW Health has set up a dedicated eHealth division and recently appointed Michael Walsh as CEO and CIO, with intensive care specialist John Lambert appointed as chief clinical information officer (CCIO).

HealthLink in the midst of a paradigm shift to online services

Over the past five years, Auckland-headquartered HealthLink has made the transition from secure messaging provider to what it calls an online services hub, undergoing an intensive development process that it says is set to completely redefine electronic referrals in New Zealand and Australia.

According to HealthLink CEO Tom Bowden, more than 70 per cent of the three Auckland District Health Boards’ GP referrals are delivered using its new online eReferral technology, and the company now provides electronic hospital referrals for approximately 60 per cent of New Zealand’s population.

HealthLink, which handles pretty much all secure messaging in both the primary and secondary health sectors in New Zealand, is trialling the new technology with a number of GPs and community-based specialists to ensure the company gets it right before offering it to both the New Zealand and Australian markets.

Mr Bowden said messaging-based referrals and specialist reports are widely used in NZ, with an average general practice communicating with 64 other parties electronically. However, the move to online services is what he calls a new paradigm that will see the traditional referral process changed completely.

“The way it works in messaging is that your EMR is used to define a referral and to pick a party you want to send it to,” he said. “That then turns it into a message and squirts it into our system, where it gets picked up by the party you are referring to. But what it doesn’t do is allow the recipient to define what he or she wants by the way of a referral.

“Our new system works with the GP selecting the referral type that they want to use and choosing the recipient from a cloud-based server. Whether they are sending a referral to a hospital or to a specialist or whoever it might be, the recipient defines what information he or she would like to receive in the referral.

“That definition then instructs the EMR as to which fields of information to send and which attachments to present.”

Mr Bowden said the EMR then automatically populates the referral with a large number of fields of information in a much more comprehensive manner. “It is the recipient of the referral who has defined pretty much what they want to get,” he said. “It is a much smarter process.”

Not only will this overcome the problem of inappropriate referrals, but it will ensure that the referrer can no longer send too much or too little information, he said. By defining the fields and allowing the EMR to take care of populating it, the referrers themselves won’t need to do much work.

“We are in the throes of introducing that now and we have put it into a number of pilot sites first,” he said. “And we are doing a lot more development work to improve the service, applying what we have learned, because in our view, the whole thing about the technology is getting it right. We’d far rather spend all our time getting the product right rather than trying to sell it. If you get the product right, it’ll sell itself.”

The online service will be able to be launched from within practice management systems, which Mr Bowden prefers to call EMR, and as all NZ general practice EMRs use a common interface based on a national standard, it will work for all.

“This is revolutionising the referral process,” he said. “With the hospital referrals, GPs have told us in focus groups that they can already see better patient outcomes from this process.”

The same EMR interface is being used for another of HealthLink’s products, the eLab pathology ordering system it has developed with Danish company DMDD. eLab allows GPs to order electronically, with the order sent directly into the laboratory’s system with no manual input required.

Mr Bowden said eLab is now used extensively in the lower North Island region following its launch in Wellington in late 2011. HealthLink will also begin a renewed push in the next few months to get the system implemented in Australia.

“Because it uses the same EMR interface, [NZ users] don’t need to change the EMR system,” he said. “You just plug it in and it pulls out the same fields and off it goes.”

The company is also implementing its Care Insight system in more NZ regions following its first introduction in Hawke’s Bay. Care Insight, which has been developed in partnership with Dr Info, allows emergency department doctors access to a summary of medical information held in the patient’s GP’s or pharmacist’s system, including diagnoses, medications and alerts.

Care Insight is now used in Gisborne, throughout Northland and in Nelson on the South Island. Mr Bowden said the company was also looking at implementing it in other parts of the South Island, as well as the first implementation in Auckland that is now underway.

While HealthLink and Dr Info have been in talks to introduce Care Insight to Australia, recent changes in health policy and health service realignment means that has been delayed somewhat. Australia also lacks a national secure network for general practices, meaning implementing it on the West Island will be infinitely more difficult than in NZ.

“There are all sorts of firewalls – or no firewalls – to try to get through in Australia whereas that doesn’t apply in New Zealand,” he said. “In New Zealand we have pretty much have a complete, universal secure network running across every general practice.

“The key to Care Insight is its reliability, so if you’ve got 100 medical practices and 10 of them are going offline all of the time, then it won’t work. Care Insight is a very elegant solution but it has to be choreographed correctly.”

MacRae officially takes charge at Patients First

Former manager of ICT at Compass Health Jayden MacRae has officially taken up the position of CEO with Patients First as inaugural CEO Andrew Terris takes a sabbatical from the industry.

Mr MacRae, who has also worked in technical operational roles with responsibility for software development and information analysis, will oversee some new developments with Patients First, including an upgrade to the GP2GP medical record transfer system and the release of new reports as part of round two of the practice management system (PMS) review.

The first paper covers NZ’s capability with patient portals, which the National Health IT Board wants to be made available to all patients by the end of the year.

That report will be followed by others on cloud hosting, IT support for PMSs and prescribing capability.

“I feel very lucky to be a part of Patients First which is a brand synonymous with highly successful sector projects,” Mr MacRae said. “I’m lucky enough to step in at a time when we are about to deliver another clutch of what will be valuable products, including the second version of the GP2GP product and a follow-up briefing series on practice management systems and patient portal offerings related to general practice.”

Patients First chairman David Moore said Mr MacRae was “a fantastic catch” for the company. “He has a great history in information systems in primary care and shared care records.”