As the journey to the PCEHR begins its approach to the station, is the end result going to be a smooth disembarkation or an absolute train wreck? The answer may lie somewhere in between, but whatever happens, it is important that the work already done on standards, terminologies and the foundation pieces of eHealth are not lost for the future.

Read the rest of my article on PCEHR here, at Pulse + IT magazine.

Have Your Say

Will the PCEHR have a happy ending or will it be a complete train wreck?  To leave a comment, click on the title of this article or the comment link just below the title.  You will see the comment section at the bottom of that page.

At HealthLink’s recent eLab roadshow, Erik Jacobsen (CEO of Danish Medical Data Distribution or DMDD) shared the numerous benefits Denmark has enjoyed since scrapping its paper-based system in favour of electronic pathology ordering eight years ago.

DMDD’s WebReq service enables fast and accurate capture of information directly from a GP’s practice management system/EMR into a laboratory information system (LIS).  Denmark is the world’s most advanced ePathology environment, with 80 labs using 13 different LIS systems and all GPs embracing WebReq.  HealthLink has worked with DMDD to make WebReq available in New Zealand under the eLab brand and it has launched successfully at Aotea Pathology in Wellington.  eLab will be available in Australia in the near future.

Key Points from Erik’s Presentation:

• Mislabelling of lab test orders has been reduced by 209,000 instances per year
• Incomplete/illegible forms have been reduced from 325,000 to 91,000 cases annually
• Unnecessary manual lab registrations have been eliminated, saving 32,500 man hours per year
•  Manual admin at lab reception has been reduced saving over 43,000 work hours per annum
• What ePathology requirements patients, doctors,  labs, hospitals and government have
• How WebReq has been fully financed by savings from pre-printed paper forms

Here are the slides from Erik’s presentation:

You can also read eHealthspace.org’s article on the Danish experience of ePathology.

Be sure to drop by the HealthLink stand at the Best Practice Summit this week to learn how to get the best out of your HealthLink account. My colleague, Rajab, and I will be showing you how to leverage the largest secure messaging network in Australia, enabling you to exchange information with over 10,000 other healthcare organisations. We’ll also be discussing how the Wave 1 and Wave 2 PCEHR programmes will affect you (HealthLink is a lead SMD service provider for these programmes).

As usual, we’ll have an iPad 2 up for grabs, so make sure you drop by the HealthLink stand and enter!

In the meantime, or if you are not able to attend the Summit, check out our updated training videos for sending a referral letter or setting up a new messaging contact in Best Practice.

It’s shaping up to be a great Summit packed with plenty of learning, fun and sight-seeing. And fingers crossed, we might even catch a glimpse of a nesting turtle or two. See you there!

January provides the opportunity to reflect on the previous year and the experiences we enjoyed and learnt from, both in our working and personal lives.  What experiences in 2011 enabled you to grow and develop?  For me, it was leading a team of Diocesan students to victory in a Dragon Boating Challenge.

I started coaching Dragon Boating in 2007 after being invited by Busting With Life, a woman’s breast cancer survivor’s team. I had just spent the previous year as their sweep, working with the coach of the corporate dragon boat team I had been a member of for seven years. Apart from five years of waka-ama outrigger canoe training, I had little coaching experience to offer but trained under an excellent coach. With a little trepidation, I then proceeded to take Busting With Life to win three consecutive nationals competitions.

Dragon Boating and breast cancer research has an interesting history which can be read in the Canadian Medical Association Journal. Besides the physiotherapeutic benefits researched here, I can attest to the social benefits, and I have no doubt there are psychological benefits to a team sport amongst members who have gone through traumatic experiences and live in fear of its reoccurrence.

Sean Ogden leads the Diocesan School for Girls Dragon Boating team to victory

Over the years my team of women have become family. One is the sister-in-law of Jo Robertson, the Leadership Programme Director of Diocesan School for Girls. When I was asked if I could help with coaching year 10 girls in a Dragon Boating Challenge, I was more than willing. Not only was this an opportunity for the girls, the Auckland Dragon Boating Association (ADBA) and the sport in general, but it was an opportunity for me to test my abilities to convey what I had learned in leading a dragon boat team. This was not just a coaching exercise. I was not being asked to baby-sit. I was being asked to teach these girls what it takes to succeed.

Leadership is a quality that HealthLink actively encourages in its employees and since the Dragon Boating event was in syngery, HealthLink had no problem donating my time to the cause.

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It is often easier to say nothing and hope things will sort themselves out.  However, when you you see the same mistakes about to occur again it is time to say something. At HealthLink we are passionate about what we are doing. We are adamant that we must learn from both the lessons of failure and the lessons of success.  Both Tom Bowden and myself have written and spoken about incremental steps in progressing the eHealth agenda and getting the fundamental building blocks right before embarking on lofty ideals.  Our submission to the PCEHR Inquiry was focused on this philosophy.  It seems to have hit the mark in the media…

Read Thursday’s full article at The Australian, including details of our submission on the PCEHR project.  You can find our submission here as well as track the other submissions received by the committee.

What are your thoughts on Australia’s PCEHR plan?  We would love to hear your comments…

The Australian space is trundling along towards even greater connectivity with HealthLink leading a number of projects at ‘Wave 2′ PCEHR sites. The latest site to go live with electronic discharge summaries is the Blue Mountains District Anzac Memorial Hospital in Katoomba. As with many hospitals around Australia, HealthLink’s position as leading secure message delivery (SMD) player in the catchment area made it an easier transition from concept to actuality.

Read more about the E-Discharge Summary project in Greater Western Sydney that will be further replicated in other areas across Australia.

This is a quick and somewhat belated sign off for the end of 2011.  We will close our office tomorrow afternoon (Friday 23rd December) but we will be open on every working day throughout the holiday period, providing support for 9000 plus medical centres across Australia, New Zealand and the Pacific Islands.  So while you are holidaying relax, because we are on the job.

While it has been a very hard working year, we have also enjoyed considerable success and it is very gratifying to look at what has been achieved. Some highlights on the New Zealand front are…

• eLab: The Aotea Pathology eLab system is now used by more than 400 referring doctors in the Wellington region and nearly 20,000 electronic pathology requests have been sent.  The rollout continues apace and should be completed in early 2012.
• CareInsight: The Care Insight system has received very good feedback from the Hawkes Bay DHB’s clinical council and we anticipate getting sign off for it early in the New Year.  Care Insight is also live in Nelson.
• eReferral: We now have eight DHB regions using the HealthLink eReferral system.  The latest and most sophisticated installation the Auckland Regional DHB eReferrals system is now live on a number of practices, more than 300 referrals have been sent and rollout is commencing in early January.

In Australia, we have had a very busy and successful year too and we are involved in a major messaging project in readiness for the Personally Controlled electronic Health Record project which rolls out in July 2012.  In Vancouver, things are underway for a rollout early in 2012.

I would like to thank you for your continued support over 2011 and hope that you, your colleagues and family have a safe and enjoyable Christmas Break.  Happy Christmas!

Many procedures in medicine rely on an agreed “standard” approach to problems. These “standards” must evolve over time as the practice of medicine evolves. Health information systems are no different and they need to embrace appropriate standards to remove the need to reinvent IT systems again and again with consequent wastage of scarce resources.

At the recent HINZ 2011 conference, my colleague Colin Simmons and I presented a poster paper on a standards-based approach used to develop an electronic pathology ordering system known as eLab.

eLab enables medical practitioners to electronically order pathology tests and have them delivered to the appropriate laboratory.  With eLab, we utilised standards to provide a consistent user interface experience, regardless of which Electronic Medical Record system users order from. Standards also provided an accurate and consistent way to identify the patient, healthcare providers and the tests being ordered, resulting in a highly efficient and useful new tool for the sector.  The use of standards in eLab helped us to achieve a faster implementation by allowing us to leverage off work done elsewhere and focus our development efforts on a high-value, low-risk solution.

To learn more, download and read our short paper on health information standards in action.

eLab has been launched at Aotea Pathology in Wellington and is now being rolled out to the greater Wellington region.

Learn more about HealthLink’s use of standards to deliver eHealth solutions.

At HealthLink we pride ourselves on our support for – and our adherence to – standards. But how do standards actually help in the delivery of solutions? More practically – how does the use of standards improve clinical outcomes?

Recently at HINZ, I presented an endorsement of the standards-based approach to developing solutions that span multiple systems.  The case study that supports my proposition is Auckland eReferral under the CareConnect brand. The standard in question – “the standard” in the rest of this presentation – is HISO 10014.2 Online Forms Architecture Technical Specification.

Standards based solutions have been good for Auckland eReferral, good for vendors and good for the sector as a whole.

The CareConnect project was a challenging one, spanning many different systems, many different vendors, 300 odd general practices in Auckland and three of New Zealand’s largest district health boards – Auckland, Counties Manukau and Waitemata.  Between them, these DHBs send almost a million referrals annually, faxed in manually.  Key problems we needed to address using eReferral were lost and duplicated referrals. Having physical printed referrals also meant there was no “single source of truth”. A referral has a life after it is faxed, with information added or changed, other documents clipped-on or stapled and notes scrawled on it by clinicians . With multiple copies these additions and amendments could be across numerous documents and could easily contradict each other.

To address these challenges we wanted to take the work done on standards and use it to clear benefit in a real project.  Furthermore, we knew that the eReferrals solution involved tying data from Primary Care into clinical workflows that took place in Secondary care. So, working in collaboration, HealthLink and Orion set up the “Open Health Consortium” so we could jointly propose a standards-based solution for eReferrals in the Auckland region. The Open Health Consortium combined HealthLink’s long experience and broad presence in Primary care with Orion’s known expertise in Secondary care.

As we learnt, the success of a standard is dependent on adoption and uptake.  It needs to support clinical outcomes and be used in a meaningful way.  Pragmatism always trumps dogmatism in the application of standards.

View the video of my HINZ conference presentation below to learn:

• Why standards are great for facilitating generic, extensible, reusable integration in a multi-system solution
• Why HealthLink decided to take the standards-based approach with CareConnect
• Six key problems the standard solves:  multiple disparate coding systems, hard coded business rules, data quality issues, high cost of change to the proprietary interfaces, low pace of change and rogue forms that bypass the subscribing systems.
• How standards were designed and implemented specifically for Auckland eReferral (CareConnect)
• How eReferral has gone – an evaluation of the application of the HISO standard and the lessons we learnt

The video is 29 minutes long and follows the full length of my presentation.

View my presentation slides on Slideshare.

Your Feedback Helps Us Improve, We’d Love to Hear From You!

Auckland eReferral supplied as part of CareConnect is going into production as I write. However, this is a living project so we welcome feedback from those in General Practice for consideration in the next phase of this programme.

• What information do you want to receive about a referral after it’s made? Status Update messages in the inbox? A status summary that appears when you re-open the eReferral? A web portal you can login to that shows all the referrals – active and historical – that you or others at your site have made?
• The HISO standard supports the submission of eReferrals but once it’s implemented in a practice management system the addition of other forms is a relatively trivial matter – what other forms do you complete that could benefit from pre-population and online submission using the HISO standard?
• CareConnect eReferral will be available under the most recent releases of MedTech and My Practice – what other practice management systems do you use where you might need to raise eReferrals?
• We want eReferrals to mesh cleanly with practitioners’ existing workflows – what other steps could we take that would make eReferrals fit more seamlessly into your processes? For example, is there value in us requesting a daily reminder when you “Park” an eReferral? How about initiating an invoice?

To leave a comment, click on the title of this article or the comment link just below the title.  You will see the comment section at the bottom of that page.

Planning for a paperless practice is essential if your goal is to establish and run an efficient, patient centric and mostly profitable practice.  Secure Messaging (SMD) should be an integral part of your plan and your chosen SMD provider will be critical to achieving your goals.

Your plan need not be complex…

1.  Check Your EMR Software Capability

It is very important that you choose your practice clinical software (EMR) application carefully. Some software is better equipped for Secure Message Exchange (SMD) than others.  Ask practices that are currently using this software what they do and don’t like about it, as well as what they can and can’t do.  HealthLink runs all common clinical EMRs in a test environment and you can ask us about capabilities, usability and functionality.

2.  Identify Your Messaging Contacts

Identify health information exchange sources and destinations creating a definitive list of the health care providers and organisations that your practice interacts with. HealthLink manages the technical complexity of SMD, creating a ‘network’ that you can readily access within your own EMR, whether you are sending referrals or receiving results, reports or letters.  HealthLink  integrates your system seamlessly with the rest of your network, giving you a level of assurance and accountability in your exchanges.

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