Blacktown Hospital test blood-and-guts proof PCs

By: Suzanne Tindal

Blacktown Hospital has run a trial of a tablet PC designed specifically for the healthcare industry — even blood and guts won't slow it down.

The Motion C5 in action
(Credit: Motion Computing)

Technically-savvy Blacktown hospital has invested a lot in its IT infrastructure — the whole hospital is wireless, including the back-end. Having introduced electronic medical records years ago, the hospital says it's always on the lookout for better ways for medical staff to record patient information on the go.

The Motion Computing C5 tablet — designed together with Intel for the health industry and available in Australia from late last year — is the latest system the hospital has trialled over three months earlier this year. The device is completely sealed, meaning a spill of urine, blood or just tea will not cause it to collapse or cross-infect other patients — it can even be wiped down with disinfectant.

The health professionals in the hospital needed to benchmark the new tablets against the running system: computers on wheels, nicknamed COWs, and their smaller brethren — calves.

The clinicians took to the Motion C5, according to Professor Steven Boyages, chief executive for Sydney West Area Health Service, with the greatest advantage being the mobility, such as being able to sit on the bed with the patient while holding the device.

The tablets' portability, however, does have one negative aspect: "The downside with these devices is they will walk," Boyages said.

The hospital has been working with Intel on answers to the problem, including using a proximity device with RFID technology built into it to deactivate the tablet when it moves out of a specified zone. Another solution is for clinicians to each have their own device and take personal responsibility for it.

A drawback to the tablet per clinician solution is the price tag, which sits around AU$3,000. "That's the other disadvantage at the moment," Boyages said, although he added that he thought the price would come down with time.

The Motion C5 also has an RFID reader and digital camera built in, although neither were tested in the trial, because the hospital doesn't have RFID or barcoding set up and its electronic medical records cannot currently store images.

However, Boyages believes these features will be very useful in the future: the RFID scanner can make sure the right drug finds its way to the right patient once the drugs and patients are tagged while the camera can measure information difficult to capture in words, such as the "size of an ulcer, the state of a wound".

Boyages sees the camera being particularly useful for community nurses who visit patients previously seen by a different nurse. In this case, to ascertain if a wound is getting better, the nurse usually asks the patient, and in typical Australian fashion, they'll often say "Yeah, I think it's better". A less subjective method of finding out how the injury is going is by looking at an image from the previous session.

The next step, according to Boyages, is to use the device in a new testing centre which is set to be opened, where the problems flagged in the trial can be ironed out.

Patients won't suddenly see all Blacktown hospital medical staff sporting the devices in the future, Boyages says, adding that technology often reaches past what enterprise systems can do, and changes need to be made before the technology can work properly in the hospital.

Flying doctors spend $2.7m on bush health records

By: Suzanne Tindal

The Royal Flying Doctor Service (RFDS) has entered into a five-year AU$2.7m contract with IBA Health to create a standardised system for its electronic health records.

(Credit: Royal Flying Doctor Service)

The new system will help the Service's health professionals with its 12,000 annual clinical appointments across regional Australia.

Clinicians will be able to remotely access a patient's medical history, including allergies, immunisation records and current medications, via the internet-based system, and update the information during check-ups.

In time, it is hoped the system will also be accessible in aircraft. The RFDS Queensland operations are already using Telstra Next G to achieve this.

Some areas the RFDS visits don't have internet access. For these places, the RFDS will work together with IBA to develop a customised system which will allow "briefcasing" of medical records — taking files that are needed on laptops and synchronising them with the system when the clinician again has an internet connection.

(Credit: Royal Flying Doctor Service)

Ideally, the files will be briefcased from a central location, according to Gary Oldman, RFDS acting national ICT manager, but it depends on the amount of bandwidth required by the application. The Service has a server room in Sydney which could be considered as the central location, however, he said nothing has been finalised.

To have a network on which the system can run, the RFDS has to link together its separate Wide Area Networks. The Service has four areas of operations: South East (NSW, Tasmania, Victoria), Queensland, Central, (South Australia and Northern Territory) and West (Western Australia). The Service has received a draft proposal from Telstra, which is looking to connect the regions via extranet.

The national network will form the backbone for other things, according to Oldman. "Once we've got an infrastructure, we can run other national programs: a national HR system; a national finance system; a national intranet."

The IBA contract includes the licence for the software, implementation, customisation, support and maintenance. Implementation work will start in July and continue to June 2009. Once the new system is in place, the old Service records will be migrated, Oldman said.

(Credit: Royal Flying Doctor Service)

The Service chose IBA Health because it had the bells and whistles but would also speak to other internal and external systems including State hospital, pathology and X-ray records, according to RFDS national health program manager Robert Williams.

"There are various products out there. However, the IBA iSoft product had the most functionality and met NEHTA standards," he said.

NEHTA is responsible for unifying medical records across the nation.

State seeking e-health damages

By: Sean Parnell

THE Queensland Government has raised the stakes in its legal row with developer TrakHealth and is seeking almost $100 million in compensation for a failed e-health contract.

When Queensland Health scrapped a $30 million hospital software contract with TrakHealth three years ago, the company took Supreme Court action to recoup $18 million in losses and unspecified damages.

TrakHealth, which was to supply a patient administration system and a clinical information system, accused the government of compromising the project and damaging its reputation.

"Queensland Health's behaviour was unreasonable and unconscionable," a TrakHealth spokesman argued at the time, as the company sought work elsewhere.

In its defence, Queensland Health involved US-based InterSystems, which now owns TrakHealth, and database pioneer Terry Ragon, filing reams of documents in the Brisbane Supreme Court to demand $21.5 million in compensation.

Queensland Health argued that TrakHealth misrepresented itself and its product, MedTrak, ahead of an order being placed in 2003, while Mr Ragon, the founder of US-based InterSystems, failed to intervene to limit Queensland Health's losses.

Earlier this month, Queensland Health amended its defence and counterclaim to seek $98.2 million in compensation to cover the increased cost of delivering such software in the current market.

Queensland Health estimates it would cost $132 million to have a similar system installed now, not to mention the cost of keeping other systems going in the meantime, well beyond the $33.81 million involved in the original deal.

"To put Queensland Health in the position in which it would have been had the plaintiff performed its obligations under the contract, it would be necessary to procure from a different software supplier a product equivalent to that which the plaintiff contracted to deliver," court documents state.

A spokesman for TrakHealth, InterSystems and Mr Ragon declined to comment.

It is understood they have until today to file documents in the Supreme Court to respond to Queensland Health's amended defence and counterclaim.

A Queensland Health spokesman said e-health remained pivotal to the future of sustainable healthcare and the department had committed to a massive information and communications technology strategy.

"This strategy aims to create a consolidated holistic view of patient care by enabling ICT investment over the next four to seven years," the spokesman said.

"It will ensure Queensland is moving towards supporting the electronic collection, transmission, safe storage and access of patient and clinical information that supports the improvement of patient care."

Queensland Health's priorities in the strategy are discharge summaries, results reporting, order entries, electronic clinical notes, statewide scheduling and comprehensive medication management.

The department, which plans to introduce new technology systems and capability "where necessary", has engaged alliance partners EDS (for enterprise architecture) and PricewaterhouseCoopers (for change and program management) to assist with this stage of the strategy.

In the Australian market, TrakHealth is most active in Victoria, but it also has contracts in Asia, New Zealand and Britain.

HealthSmart two years behind schedule

By: Karen Dearne

VICTORIA's troubled $320 million HealthSmart project has failed to get the cornerstone Cerner clinical system working at any of its sites, and has replaced only one of 10 Homer hospital systems, which were obsolete when the program began four years ago.

Auditor General Des Pearson said HealthSmart was at least two years behind schedule and more than half of the budget had been spent with only 24 per cent of the planned installations complete.

In a long-awaited review, Mr Pearson said the original budget, which involved health agency co-funding, was not realistic, and the targets were too ambitious.

Victoria's Human Services Department and the Office of Health Information Systems have consistently deflected concerns raised in the state parliament by vendors, industry observers and even an anonymous group of healthcare workers.

The project judged most at risk, but with the greatest potential benefit, is Cerner's Millennium clinical suite, which includes health records, electronic scheduling, diagnostic services, results reporting, and e-prescribing capabilities.

"The first release of the clinical system has been tested by various user groups and is ready for use, but none of the four lead agencies have committed to using the new system," the report says. "According to the original timelines, the acute hospitals in 10 health agencies should be using clinical systems by now, but even if funding negotiations are concluded shortly, the first four agencies are unlikely to meet the June 2009 completion date."

The $79 million deal with Cerner was signed in March 2006, but costs rose by $17 million to $96 million in 2006 -- the biggest price blowout in the program.

A Cerner spokesman yesterday declined to comment, citing contractual obligations.

Replacement of the antiquated Homer hospital system with a modern Patient and Client Management System has also been fraught. HealthSmart initially signed a $50 million contract with local firm iSoft in 2003 to replace the legacy system with iPatient Manager, an "interim" product that would in turn be replaced with Lorenzo, a highly capable next-generation suite.

ISoft ran into difficulties supplying systems to the British National Health Service Connecting for Health program, and was subsequently acquired by another Australian firm, IBA Health Group.

Communications director Greg King said IBA Health was "comfortable tracking to the time frames set by HealthSmart" for completion in 2009.

"The procurement process took longer than expected and the project started nine months later than anticipated, so the department, lead agencies and we as vendor are doing quite well catching up," he said.

"We've got nine lead agencies in our portfolio. We already have three live, we have one in implementation and two others are in the planning stage, so we've only got three sites pending."

Mr King said it was "always good to have a third pair of eyes looking at large projects" such as HealthSmart.

"We don't see anything in his report that we have any major disagreement with," he said.

Oracle achieved the best result among technology suppliers, with its E-Business financial management system implemented in eight of 11 participating agencies. The remaining three were due for completion this month.

Mr Pearson found the Oracle project came in $500,000 over the original budget, at $26.8 million.

TrakHealth has set up its standalone Client Management System in two community health centres, and a further 10 sites wish to install the product.

Mr Pearson found there was "room for improvement" in the shared services arena, where underperformance had a knock-on effect on systems availability.

Meanwhile, a lack of interest by agencies in taking up the payroll system might "trigger" payment of a revenue guarantee to the vendor.

Victorian shadow minister for health Helen Shardey said the auditor's findings were not unexpected, but the extent of the project's failure was a surprise.

"We have supported this kind of technology to bring our health system into the 21st century, so the massive failure is a tragedy," she said. "The project has been completely botched, and it points to a government that is just not capable of delivering on these important projects."

SA pumps $17m in e-health

By: Jennifer Foreshew

THE South Australian government will provide nurses and midwives with instant access to patient records under a new $17 million web-based information system.

SA Health Department chief information officer David Johnston said the technology would provide faster access to patient information and lead to more responsive and informed treatment.

"All major public hospitals will be linked which will help improve areas such as patient care planning, care quality management and patient acuity, as well as workforce utilisation of our nurses and midwives,'' Mr Johnston said.

The project is part of the State's electronic health records system, careconnect.sa, which will link all clinicians and patient information within the next 10 years.

Developed by Sydney-based Emerging Systems, the technology will be introduced at Lyell McEwen Hospital in Adelaide first and progressively rolled out to 17 public hospitals across the State by the end of next year.

The system includes a risk assessment profiler for each patient and a variance tracking tool that uses a patient care guide to monitor treatment.

Govt woes don't trouble TrakHealth

By: Ben Woodhead

MEDICAL software heavyweight InterSystems is eying big ticket hospital software projects in South Australia and Western Australia as it moves to capitalise on its acquisition last year of local firm TrakHealth.

But the company has acknowledged that the spectre of TrakHealth's legal battle with the Queensland Department of Health in relation to a failed patient and clinical systems initiative still looms over its meetings with other public sector organisations.

"Obviously everyone asks questions about it but moving on what's important is that we have a good product," TrakHealth chief operating officer Christine Chapman said.

Ms Chapman declined to confirm if the company was holding settlement discussions with Queensland Health over the hospital software project, which collapsed acrimoniously in late 2006.

TrakHealth subsequently said it would pursue $18.2 million in damages from Queensland Health but the health agency promptly fired back with a $21.9 million counterclaim against TrakHealth.

The matter is expected to go to trial in the Queensland Supreme Court this year if the two parties are unable to reach a settlement.

Ms Chapman said that InterSystems is now hiring software developers locally as it works to build up TrakHealth's development team following the acquisition in May last year.

The company has added six new developers over the past 12 months and has hired a full time recruiter to look for additional staff.

The hiring comes as InterSystems works to sell TrakHealth's TrakCare product into its international customer base, which includes a number of organisations with large healthcare operations such as the US Department of Veterans Affairs.

The company is also looking at public sector opportunities in Australia including Western Australia's $335 million eHealthWA project and a South Australia Department of Health patient software initiative worth tens of millions of dollars.

Ms Chapman said that InterSystems, a long time partner of TrakHealth, had acquired the company because of the strengths of its intellectual property.

She poured cold water on suggestions that the purchase was prompted by TrakHealth's weak financial position, which included losses worth more than $40 million over the last four years.

She also said that past financial performances did not reflect on the future sales prospects for the TrakCare product.

"Healthcare is a bigger company business," Mr Chapman said."(TrakHealth) was a small company and it was not able to bid on a lot of the bigger contracts."