Electrifying Progress

Medical One & Zedmed

The National E-Health Transition Authority (NEHTA) is tasked with identifying and fostering the design and development of technology to deliver Australia’s future e-health system. According to this authority, “an eHealth record will help you better manage your health. It will give you more control over your health information and ensure the doctors and nurses treating you, and your family, have the information they need.” Electronic health records “will greatly enhance both the quality and the timeliness of available healthcare information, delivering substantial benefits to you, your healthcare provider and the healthcare system as a whole.”

So much for the theory, but how is this paradigm shift progressing at the coal face – or at least in the medical centre? Victoria-based Medical One has achieved e-health compliance with commendable speed, with considerable input from software supplier Zedmed, which was the first to achieve PCEHR compliant software. Karen Perham, General Manager of Medical One, says that on the patient side, little is known at this stage because an advertising and awareness programme has not yet gotten under way. The programme to encourage everyone to apply for a PCEHR was launched last July and has been “one of the softest roll-outs in history.” It was necessary to get the industry – doctors and software suppliers – conversant and compliant before prompting a stampede of applications, she says.

Jane Blakeley, Business Analyst for Zedmed, says there is some understandable caution on the part of the medical profession, a normally conservative sector. “But with the PCEHR you are not uploading the entire patient record but only the parts that are relevant, and only with the patient’s permission, so the doctor retains control. It is all fully transparent,” she explains. Doctors do have some concerns about privacy and, perhaps more important, about a possible serious addition to their workload with no significant recompense from government. But Jane says the system has been designed to make everything simple, virtually a one-click operation rather than a mountain of e-paperwork. “There is really very little training involved; the difficulty has been in getting registered.” The need to deal with multiple layers of government has not made this any easier and Zedmed fields a steady stream of enquiries from practices asking for help.

These are separate, independent companies but they share an owner, Dr Peter Stratmann. Zedmed, in its earliest guise, was a leader in medical software and systems even before the PC era, while Medical One has emerged as a leading provider of health care services in Victoria and South Australia with ten medical centres in Melbourne (starting in 1990 in Taylors Lakes, with two young GPs fresh from the hospital system) and one in southern Adelaide.

Karen is understandably keen to keep the powder dry in relation to future growth, but says the leap into South Australia is early evidence of the company’s intention to expand. “We would like to go interstate,” she says. “Choosing areas with needs is always a challenge. We are constantly on the lookout for good sites – we have very clear guidelines on what constitutes a good site – and certainly there are a couple more planned for the coming years.” Medical One has a mix of greenfield sites and acquired existing centres; each has its own challenges and opportunities and Karen believes there is a balance to be struck between the chance to build an ‘optimum’ design on a new site and the need to alter the culture of an existing practice. As for the Medical One culture, it’s all about making the centre a good place to work, with open communication, honesty and a bit of fun in addition to the provision of first-class medical services.

This leads on to the fact that Medical One prides itself on being leading-edge in terms of systems, computing and e-health. Zedmed has been part of the medical software vendor panel that has worked with the government to implement the building blocks they needed to have in place for the PCEHR programme. The company was one of the first four commercial suppliers to enter into a formal agreement with NEHTA to incorporate national e-health specifications and standards into existing clinical desktop software products.

A fully compliant system for submitting and controlling PCEHRs is now part of the Zedmed suite, which consists of two main products: Office and Clinical, the former covering everything front-of-house, from scheduling to financial and management reporting, and the latter providing prescribing and secure exchange of information as well as comprehensive clinical tools, summaries and assessments. One of the Medical One sites (in Geelong) became the first in Australia last October to upload a clinical document (a shared health summary) directly from a GP practice management system (ie without using third-party software or bolt-ons but seamlessly from within the practice system) to an individual’s PCEHR.

An important aspect of the e-health programme is the ‘healthcare identifier’ (HI). Zedmed has been working on integrating HIs to become Electronic Practice Records-compliant and there are five elements to this: Secure Messaging Capabilities (additional testing being completed), Data Records and Clinical Coding (compliant using ICPC2+), Electronic Prescriptions (compliant using eRx and Medisecure), and PCEHR (compliant). These five requirements will form part of the new e-health Practice Incentive Program (ePIP). The government has indicated that the first four capabilities will be required to be in use in general practices by February 2013, while the sharing of health and event summaries to the PCEHR will be required by May 2013. To ensure readiness for ePIP, practices not only need to check their medical software is compliant, but that they have registered with the HI service and prepared the necessary prerequisites for PCEHR access. To simplify this process Zedmed has developed an e-health area on its website, with step by step guides.

Medical One, in turn, went through all the processes needed in order to access the PCEHRs, so between them the two companies are in pole position as the system develops and spreads nationwide. “This has been very confusing for most medical practices throughout Australia,” Jane admits, “but Zedmed is now in a wonderful position because we have the systems and processes in place and can guide medical centres through the entire process of registering with various government departments in relation to the PCEHR, not just providing software but taking them through the whole procedure and becoming e-PIP compliant.”

Jane says a large number of practices have put up their hands to be early adopters for the system, and that they are currently finalising their PCEHR pre-requisites, including registering themselves to access the PCEHR and receiving their interim NASH/PKI certificates. The company currently has a number of practices with PCEHR access up and running, and Jane explains that, “We would anticipate that we will have [additional] practices up and running fairly soon. We are really pleased for our clients as they will have confidence that they will be eligible for their e-PIP requirements and have everything in place and it won’t all be happening at the last minute.”

Zedmed has had HI Service interface capability in its software for more than a year, and the search and validation service for HPI-Os and HPI-Is in its current version. The software also currently supports the ETP requirement, with the ability to use either the eRX or the MediSecure prescription exchanges. It will also have full Secure Messaging Delivery (SMD) standard capability shortly. “We are working with both Argus and HealthLink on SMD capability and my understanding is that they and Global Health are working together on a project to work inter-operably. We are completing final testing now, which means SMD will be signed off and compliant in the coming days.”

Change is always problematic and there is an understandable fear of the unknown, but doctors should not be afraid of an increased workload when dealing with and uploading data to PCEHRs, says Jane. The whole system will be of most benefit to patients with chronic illnesses of complex symptoms, as well as to patients who move around the country a lot or who are seen by many different doctors (and those in rural and regional Australia, as championed by the NRHA – see A Fair Go, in this issue).

There is no longer any need for patients to remember all their various medications, for example; quick and easy access to information makes for better health outcomes for everyone – on both sides of the GP’s desk. Within a practice, of course, all the doctors have the same access to the same information so can see immediately what the situation is with any patient who presents. “It’s a huge advantage,” says Karen; Medical One is a total convert and will be happy to vouch for the system to anyone that will listen!

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November 23, 2017, 8:41 AM AEDT

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