Uniform health system in the mill

By: Karen Dearne

LARGE-SCALE production pilots of a nationwide e-health system will start this year, with the National E-Health Transition Authority set the task of making this happen as quickly as possible.

Peter Fleming says he hopes to run pilot projects this year

NEHTA chief executive Peter Fleming has been given a mandate to create a uniform IT infrastructure, starting with an incremental build-out of existing clinical and communication platforms.

Federal and state government agreement on the urgent need for healthcare safety and efficiency gains - detailed in several recent reports - signals an end to years of under-investment and fragmentation as parties pursued their own technology agendas.

"Legislative changes are needed, but from a technical perspective we aim to be in a position this year to run some pilots," Mr Fleming said.

"We're in very close dialogue with a number of groups about trials of electronic medication management and hospital discharge summaries."

Late last year, the Council of Australian Governments approved $218 million in funds to extend NEHTA's operations.

Mr Fleming said the organisation was working with software vendors to assess their capabilities and move towards the goal.

Medical Software Industry Association president Vincent McCauley said members were "hopeful this is the year things happen".

"That, of course, remains to be seen, but we're keeping our fingers crossed," Dr McCauley said.

The association is advertising for a part-time general manager in response to increased industry involvement in consultations over national projects.

IBA Health Group chief executive Gary Cohen said there had been a fundamental shift in attitudes, and "not many in healthcare are interested in trying to preserve their own patch" any more. "People have realised that we have to do things differently, and we need a more national approach to healthcare delivery," he said.

Mr Cohen said the Rudd Government should be "emboldened" and develop a vision of investing in healthcare IT infrastructure. "There should be a central funding body that's responsible for allocating funds for infrastructure," he said.

"People within state health departments are locked into a particular environment - really, only the federal government has the capacity to make those big changes," Mr Cohen said.

Helen Hopkins, outgoing executive director of the Consumers Health Forum, said there was more recognition among health professionals and bureaucrats that people were important stakeholders.

"Consumers want access to their health information when and where they need it, so we're continuing to push for a full e-health record," she said.

"If that's going to take some time, they want some easier things first, such as their hospital discharge information to be sent to their GPs," she said.

Uniform health system in the mill

By: Karen Dearne

LARGE-SCALE production pilots of a nationwide e-health system will start this year, with the National E-Health Transition Authority set the task of making this happen as quickly as possible.

Peter Fleming says he hopes to run pilot projects this year

NEHTA chief executive Peter Fleming has been given a mandate to create a uniform IT infrastructure, starting with an incremental build-out of existing clinical and communication platforms.

Federal and state government agreement on the urgent need for healthcare safety and efficiency gains - detailed in several recent reports - signals an end to years of under-investment and fragmentation as parties pursued their own technology agendas.

"Legislative changes are needed, but from a technical perspective we aim to be in a position this year to run some pilots," Mr Fleming said.

"We're in very close dialogue with a number of groups about trials of electronic medication management and hospital discharge summaries."

Late last year, the Council of Australian Governments approved $218 million in funds to extend NEHTA's operations.

Mr Fleming said the organisation was working with software vendors to assess their capabilities and move towards the goal.

Medical Software Industry Association president Vincent McCauley said members were "hopeful this is the year things happen".

"That, of course, remains to be seen, but we're keeping our fingers crossed," Dr McCauley said.

The association is advertising for a part-time general manager in response to increased industry involvement in consultations over national projects.

IBA Health Group chief executive Gary Cohen said there had been a fundamental shift in attitudes, and "not many in healthcare are interested in trying to preserve their own patch" any more. "People have realised that we have to do things differently, and we need a more national approach to healthcare delivery," he said.

Mr Cohen said the Rudd Government should be "emboldened" and develop a vision of investing in healthcare IT infrastructure. "There should be a central funding body that's responsible for allocating funds for infrastructure," he said.

"People within state health departments are locked into a particular environment - really, only the federal government has the capacity to make those big changes," Mr Cohen said.

Helen Hopkins, outgoing executive director of the Consumers Health Forum, said there was more recognition among health professionals and bureaucrats that people were important stakeholders.

"Consumers want access to their health information when and where they need it, so we're continuing to push for a full e-health record," she said.

"If that's going to take some time, they want some easier things first, such as their hospital discharge information to be sent to their GPs," she said.

Intel invests in systems to help chronic care patients

By: Don Clark

INTEL is taking its next step in building a business in healthcare, introducing technology to help home-care patients with chronic medical problems.

The Silicon Valley company, at a medical conference in New Orleans, announced a series of trials for healthcare organisations of specialised hardware and software developed by the chip maker.

The tests are designed to show whether the new tools improve results in treating conditions such as diabetes, hypertension and heart disease.

Intel and other computer related companies see big opportunities in healthcare, hoping to address inefficiencies that will become more costly as patients and caregivers get older.

Allowing more people to receive care at home can save billions of dollars, the companies say.

Intel's offerings - collectively called the Intel Health Guide - include a simplified computer and software designed to help elderly people and other patients monitor and manage their conditions at home.

It connects to medical devices such as scales, blood pressure monitors and glucose readers, recording information that can be shared with health professionals over the internet. Intel also has developed software to help staff at medical call centre remotely monitor patients' conditions and manage their treatment. It will manage patient monitoring systems for customers as well. "We are going to do end-to-end services," Intel digital health group vice-president and general manager Louis Burns said.

That's a new approach for Intel, which has been studying medical issues since 1999 and kicked healthcare efforts into a higher gear in 2005.

The company ordinarily makes components that other companies assemble into systems. In other cases, Intel makes prototype designs that it offers to hardware companies - including a tablet-style computer for nurses.

But in managing home care, Mr Burns said healthcare organisations wanted a complete system that could be customised for their needs. Intel is discussing pricing for its latest offerings, in part because each deployment may differ greatly in size and scope.

There are many obstacles. Intel's Health Guide, for example, had to be approved by the US Food and Drug Administration, a process that took several months. The company also hopes to deliver its software to patients on conventional laptop and desktop computers and mobiles, but each combination of hardware and software would have to go through FDA approval processes, Intel product research and innovation director Eric Dishman said.

Who pays for such advances is another issue. Medicare, which covers many elderly patients, had not yet been willing to reimburse patients or caregivers using remote monitoring systems, said Marc Holland, research director at Health Industry Insights, a unit of technology analyst IDC. "Unless and until Medicare gets on the bus, it will be slow going," he said.

There is also likely to be plenty of competition - some of it aided by an Intel-spearheaded consortium called Continua, which has been developing standards to help medical devices exchange information, he said.

Still, Mr Holland said, he was "very excited" about Intel's new offerings and the involvement of companies that would test them, which included Aetna, Erickson Retirement Communities and SCAN Health Plan.

Another company, Advanced Warning Systems, said it planned to use the Intel technology in services to monitor patients such as retired football players and war veterans.

ICSGlobal sues Medicare

By: Brett Winterford

update Electronic health transaction company ICSGlobal has filed a lawsuit against Medicare Australia, accusing the Federal Government agency of anti-competitive behaviour over the development of its e-health transaction network ECLIPSE.

ASX-listed ICSGlobal said it had invested some $20 million and the better part of eight years into the development of an online exchange network dubbed THELMA, which connects private insurers, banks and healthcare providers to manage the settling of healthcare-related transactions.

The company claims to have made this investment under the assumption that the Federal Government had no interest in facilitating such electronic exchange itself.

But in 2004, the Federal Government announced the release of ECLIPSE, its own system for managing such transactions. The initial modules of the system went live in July 2004.

ICSGlobal subsidiary THELMA today confirmed it had now filed an application and statement of claim in the Federal Court alleging that Medicare contravened the Trade Practices Act by launching a service that competed with its business.

Tim Murray, CEO of ICSGlobal, said the company spent a full year in the 1999/2000 time-frame scoping the market for a medical transaction exchange network after private hospital customers informed him of a need for such a solution.

"We knew we were about to invest a substantial amount of money," he said. "Twice we went and saw both HIC [Medicare Australia's predecessor] and the Minister for Health [at that stage Dr Michael Wooldridge] in 2000 and in 2001. And we asked them: 'Do you have plans to address this problem in the private sector?'

"They both said no, on both occasions. They both said, in fact, congratulations, it is fantastic to see the private sector stepping in to do this."

THELMA went live in 2001. In 2002, HIC called for requests for tender for a system Murray claimed was "basically another THELMA." But the CEO derided this tender as "a sham".

"You can tell if a tender is a sham when they ask that all the intellectual property of the system has to be assigned to HIC, that the solution proposed has to be free of charge, and under the full control of the HIC. What private sector business could do that?" he asked.

"So sure, people responded to the tender, but they all said you can't have our intellectual property and we have to charge something. HIC then calls them invalid tenders."

Murray claimed HIC only put out the request for tender to convince the Federal Government of a need to build its own system. He claimed HIC approached the newly appointed health minister, Kay Patterson, following the tender asking for in excess of $50 million to build ECLIPSE.

"Once they closed the tender process, they [HIC] could then go to the Government and claim that there is nothing in Australia that can meet HIC's requirements," Murray said. "They could say, hand on heart, that because nothing like this exists, they will have to build it themselves."

Asked if ICSGlobal had any documented evidence that HIC/Medicare made any promise not to develop such a system back in 2000, Murray said his proof was limited to "minutes of meetings".

But Medicare/HIC's actions only became illegal, Murray alleged, by virtue of its offering the same service as an existing private sector company at zero cost. ICSGlobal interpreted this practice as being in breach of the Trade Practices Act.

If Medicare Australia charged a commercial fee that reflected the true cost of providing e-health services to the private health sector, he said, they'd be competing on a level playing field with THELMA, and the better solution would win.

"We would welcome the competition," he said. "But you can't have taxpayers' money being used to set up cartels to provide free products and services simply to kill off the private sector."

Murray claimed ICSGlobal's business "is still growing" in Australia, despite the conflict. But he claimed the development of ECLIPSE has forced his company to take most of its business offshore.

"You reach a point where you are trying to compete with a free product," he said. "Large chunks of the private health sector are saying, we like your system, but there's a free system coming so we'll wait for that."

Waiting, he said, was what the sector was becoming used to from Medicare. Murray accused Medicare of spending over a billion dollars on failed technology projects and said that the hospital claims module of ECLIPSE was running five years late.

"It's in Medicare's interests, to protect their position of power, to make sure the health industry stays inefficient," he argued. "Medicare is an empire for processing paper. History has proven they will aggressively target anything that threatens that."

A spokesperson for Medicare Australia said it "intends to vigorously defend these proceedings."

The case will go before the Federal Court on 4 September.

Austin Health saves ancient apps

By: Suzanne Tindal

Melbourne healthcare provider Austin Health has moved key applications from a legacy Reality-X platform, which developers had not touched in 10 years, to a modern system by software company Intersystems.

(Credit: Austin Health)

Time had been ticking for the health organisation, which employs thousands of staff and treats tens of thousands of patients, because the contracts for the Reality-X platform, which supported specialised applications the company used in its everyday operations, were ending.

"We basically run our IT department on an oily rag," Austin Health application services manager Paul Girdler said. "We were going to be sinking a lot of money into legacy systems."

Girdler said that he had been considering a rewrite of the old applications sitting on the platform to escape the costs, but that such an action would have cost in the order of $200,000.

Instead, Girdler decided to buy the answer to his problem from Intersystems, moving the applications to the firm's CACHÉ platform and thus coming to a more reasonable estimate for keeping the applications running off the Reality-X platform of $60,000 for hardware, staff costs and software.

Having run TrakCare by the same company, Austin Health already had a conduit to Intersystems, Girdler said.

"That made it easier for us to make the decision," he said, although he added that there were no cost savings from already running an Intersystems product, except for having staff already trained up.

Since deciding on Intersystems, Girdler has moved the largest and most complex of the applications, a booking system for a dozen departments such as physiotherapy, psychiatry, social work and speech pathology, to the new platform.

We basically run our IT department on an oily rag

Paul Girdler

"We figured if we can't get that one across, there's not much point in doing the others," he said.

Having successfully shifted the application away from Reality-X, Girdler has progressed to seven other applications.

His developers now have an interest in the application, because they don't have to write MultiValue code to extend it, Girdler said. Instead they use CACHÉ, which he said was a dialect of Visual Basic.

Their programming skills will be put to good use next year to change the user interface for the applications, he said, because although they will have been moved to the new platform, they will still look and feel like a green-screen legacy application, one of the disadvantages of not doing a rewrite.

IBA Health posts record earnings

By: Karen Dearne

IBA Health Group has claimed the title of Australia's leading health software company with revenues of $361 million for the 2008 financial year, up by 381 per cent over the previous year.

Chief executive Gary Cohen announced a net profit of $49 million, up 113 per cent, after completing the takeover of its former rival, iSoft, in October last year. However, the profit result included $35 million in acquisition, integration and other one-off costs.

The rise in revenue, from $75 million in 2007 to $361 million, reflected the company's expanded global footprint and continuing strong income from existing products.

"Twelve months ago we were an IT company focused on the delivery of healthcare solutions, primarily in the Asia-Pacific region," Mr Cohen said. "Fast-forward to the present and we are one of the largest providers of healthcare solutions worldwide, with more than 13,000 customers in 35 countries and nearly 3800 employees.

"With operations across five continents, our business now generates more than 85 per cent of its revenue from outside our traditional territories in Australia and Southeast Asia."

IBA, which has retained the iSoft brand for its healthcare products, expects its next-generation web-based architecture, Lorenzo, to become the "global standard in healthcare IT systems".

Lorenzo has been deployed to early adopter sites in Britain's National Health Service IT reform program in conjunction with its partner CSC, and at university hospital sites in Germany and the Netherlands.

Mr Cohen claimed that IBA was also pioneering technologies such as affordable multimedia interfaces, remote consultation systems and more advanced electronic health records.

During 2008, the company won new business in Russia, South Africa and Mexico, and in the next 12 months it plans to open new operations in Dubai and South Africa.

"Asia also presents a key growth opportunity for the business," he said. "We are planning expansion into China, Indonesia, Taiwan, Brunei, Thailand and India."

In England, IBA rolled out its iPatient Manager hosted solution to more than NHS hospital trusts, and deployed the clinical product, iCM, in several sites in the London and Southern clusters.

And in Australia, the company won new contracts with health departments in South Australia and Tasmania.

IBA's Lorenzo nabs first customer

By: Karen Dearne

MACQUARIE University Private Hospital in Sydney is set to become Australia's first user of Lorenzo, IBA Health Group's next-generation platform, in a $7.6 million deal for advanced healthcare applications to be installed at the high-tech hospital due to open next year.

A $140 million joint venture between Macquarie and Dalcross Private Hospital is funding the construction of a 180-230 bed facility in the university's research precinct, with the aim of providing high quality patient care as well as opportunities for post-graduate medical training and health research.

IBA will supply its Lorenzo Acute Care suite of clinical, administrative and financial applications across the hospital and specialist clinics. The package includes full electronic medical record functionality, and will link to new systems for radiology and pathology.

Dalcross chief executive Carl Adams said the investment would allow management of the new facility "with a confidence that the essential administrative and clinical requirements can be achieved immediately, while ensuring a pathway to the next-generation" of health information systems.

"As an early adopter, we aim to play an active role in the development program and, with other users, help shape the future of healthcare IT," Mr Adams said.

IBA chief executive Gary Cohen said the contract marked a milestone that would help drive sales of Lorenzo in the region.

"With Lorenzo, everyone has the opportunity to play an active role in the delivery of care," Mr Cohen said. "It breaks down barriers to critical clinical information, helping health professionals to make faster informed decisions.

"There is a revolution in healthcare in which Lorenzo will have a central role."

Macquarie University Private Hospital will also be the first Australian hospital to install iSoft Financials, an integrated suite of web-based financial and purchasing products called Integra.

Yesterday, IBA claimed the title of the nation's leading health software company with revenues of $361 million, up 381 per cent from $75 million in 2007.

IBA registered a net profit of $49 million, up 113 per cent, after completing the takeover of its former rival, iSoft, in October last year. However, the profit result included $35 million in acquisition, integration and other one-off costs.

IBA expects Lorenzo - built on Microsoft's .NET platform - to set a new global standard for healthcare IT.