HINZ Conference 2005 Programme

What is HL7 Version 3? HL7 Version 3 is a lingua franca used by healthcare computers to talk to other computers. The name HL7 comes from 'Healthcare' and the top level (Level 7) of the Open Systems Interconnection (OSI) model, which carries the meaning of information exchanged between computer applications. HL7 Version 3 is mainly used in large interoperability projects, such as the NHS Connecting for Health programme in the UK, Health InfoWay in Canada, etc. Version 3 has significant differences from HL7 Version 2, which is mainly used within individual hospitals . This text from the HL7 Australia V3 Resource Page.

The National Program for IT is a 10 year program to build an information infrastructure to improve patient care in England. HL7v3 was chosen to deliver the messaging requirements, with the National Program working as an early adopter developing message specifications where needed. This talk will be in two parts. Firstly a look at HL7 from the perspective of NPfIT, and then a discussion of how HL7v3 and NPfIT have affected other healthcare interoperability projects in the UK. There will be discussion of the issues encountered in some of these projects, and solutions adopted. Charlie will also cover how the HL7UK affiliate is adapting to support successful adoption of HL7 specifications.

Canada is in the midst of a series of strategic initiatives to enable inter-operable jurisdictional electronic health records. Canada Health Infoway, as coordinator of the initiative, has identified HL7 version 3 as a fundamental part of the standardization required to enable the EHR. Lloyd will discuss some of the reasons for selecting HL7 version 3 as a central component of the initiative, and will describe some of the approaches taken by Canadian projects in managing the design, development and implementation of HL7 v3 artifacts.

Paul St. Jacques M.D. is an Assistant Professor in Anesthesiology at the Vanderbilt University School of Medicine, Nashville, TN. Dr. St. Jacques attended Johns Hopkins University School of Medicine and completed his anesthesiology residency at Johns Hopkins Hospital. Dr. St. Jacques practices clinical anesthesia at the Vanderbilt University Medical center. He is the Associate Director of Perioperative Informatics and the Director of Anesthesiology Informatics. Additionally, Dr. St. Jacques serves as Chairman of the hospital's Transfusion Committee. Most recently, Dr. St. Jacques has been appointed to the ASA Committee on Information Management. Dr. St. Jacques' research interests have focused on developing software and hardware solutions for perioperative information management. These initiatives have focused on improving the safety and efficiency of the perioperative process. The Vigilance system, a computerized software and hardware solution which integrates patient data and video from multiple O.R.s. has been featured on the CBS Evening News and the CBS Early show.

eLearning has improved academic service delivery within the Faculty of Medical and Health Sciences, University of Auckland; the competitiveness of the Faculty; and the competence level and skills of graduate and postgraduate nursing, pharmacy and medical students. We will describe how this has been achieved by outlining the Faculty's Learning Technology Unit's (LTU) learning theory and instructional design principles. The theory and principles demonstrate that a Learning Management System (LMS) is necessary for eLearning; an LMS is not, however, sufficient in all cases for successful eLearning.

Michelle Honey is a Registered General and Obstetric Nurse with experience in surgical, cardio-thoracic, intensive care, nurse education and informatics. Now in the education sector again, Michelle is a lecturer at the University Of Auckland, School Of Nursing, while completing research in e-learning for nurses for her PhD.

John Wellingham MBBS, BSc (hons), DCH, MRCP, FRNZCGP

John is 0.6 FTE Primary Care Advisor to Waitemata District Health Board and 0.4 FTE Medical Director of the Chronic Care Management (CCM) programme. John’s key responsibilities in CCM include the Diabetes, CVD, COPD modules of the programme and a module to support CarePlus. He is also responsible for development of the electronic clinical decision support (ECDS) processes and the community linkages for all modules. In his WDHB role he is responsible for effective working relationships and integration between the DHB and Primary Health Care, particularly PHOs, aimed at maximizing the joint capacity of health system teams, as outlined in the Primary Health Care Strategy, and supported by the recent capitated funding approaches. He has a background in 20 years of general practice, seven years as Director of the Quality Assurance Unit for General Practice in the Auckland Medical School, and five years in DHB integration teams. He is currently doing a Masters in Health Management at Auckland University, and undertook a WHO Fellowship in June 2005 to review current overseas approaches to increase successful patient engagement in early intervention programmes such as chronic care.

Andrew Pullan is currently an Associate Professor in the Department of Engineering Science, and a senior member of the Bioengineering Institute, both at the University of Auckland. Andrew also has an Adjunct appointment in the Department of Surgery at Vanderbilt University in the US. He has held visiting fellowships at a number of locations, including Oxford University, Duke University, The University of Utah and The University of California.

Andrew currently holds a James Cook Research Fellowship from the Royal Society of NZ, widely regarded as New Zealand’s most prestigious science and technology award. He leads research programs focusing on the electrical activity of the heart and the gastrointestinal system and has successfully obtained funding from a variety of local and international organisations to continue this research. He has recently authored a book entitled Mathematically Modelling the Electrical Activity of the Heart.

Currently it is difficult to quantify the direct benefits that Clinically Integrated Systems (CIS) have on patient care delivery. However, when new systems and processes are developed and underpinned by a computerised programme to support their implementation, the interrelationships and complexity of care delivery can be uncovered. The following case study outlines how a CIS can have a positive impact on patient and organisational outcomes.

Annie Fogarty is the coordinator for the A+ Network Centre for Best Patient Outcomes which developed and implemented the CIS Model into clinical practice in 2000 .The Centre members come from a variety of professional backgrounds with previous experience in engineering, medicine, nursing and business management. The members work in partnership with clinicians and patients/ whanua to continually enhance patient care delivery.

Warfarin is an anticoagulant drug used to manage venous thrombosis, pulmonary embolus and several heart condi-tions. It has proved a valuable drug but requires close monitoring to prevent overdose and bleeding. In New Zealand anticoagulant monitoring is not managed consistently and the "safe use of medicines" group have recognized the po-tential dangers of poor control. There are several elements to safe anticoagulant monitoring with accurate dose ad-justment and consistent follow-up as essential. However many other procedural factors need to be in place to ensure patients are tested on time and to identify poor compliance and patients who do not attend for regular testing. All of these processes can be managed with a computer system. Studies have shown that computer dosing is as good as man-agement by a clinician. In fact in many countries patients are given the opportunity to manage their own warfarin and to test themselves using a home testing device. Self-testing is now available in New Zealand but these patients have little access to clinical support. In this paper we propose a model to manage anticoagulant therapy using a web-based anticoagulant programme which is accessible to both general practitioners and patients performing self-testing.

Dr Paul Harper, MD, FRCP, FRACP, MRCPath. Consultant Haematologist at Auckland Hospital since March 2002. I have a special interest in the investigation and management of patients with clotting and bleeding disorders. I carried out research on the causes of venous thrombosis at Cambridge University UK and I am continuing research in the same field in Auckland. I have contributed a major textbook on Haemostasis and Thrombosis (Bloom, Forbes, Thomas, and Tuddenham) and I have published a number of papers on the causes, diagnosis and treatment of venous thrombosis. I am secretary of the Australasian Society of Thrombosis and Haemostasis. I developed and manage the society’s discussion web-site. I have an interest in the use of IT in the management of clotting disorders and recently ran an on-line audit on the management of thrombosis.

A multidisciplinary project being launched at Victoria University of Wellington will seek to contribute to a theoretical and evaluative framework for Nursing Informatics initiatives. The project is based on the development of a wireless information system for district health nurses built around an analysis of information needs and current practice of district nurses. A brief overview of the current state of frameworks for Nursing Informatics identifies a very high level software development lifecycle, from requirements capture through to evaluation. The new framework is to be tested and extended through the district health nursing project with a view to enhancing nursing practice and improving clinical outcomes, as well as advancing methodological approaches to the field of nursing informatics.

Peter Komisarczuk is a senior lecturer in the School of Mathematics, Statistics and Computer Science at Victoria University of Wellington. He is a specialist in computer networking and distributed systems with over 20 years experience in the network industry both as researcher, practitioner and teacher. He has worked internationally for Nortel Networks, Fujitsu and Ericsson.

I present a cross-platform medical database of general utility, created using freeware tools. The database can be inter-rogated using Structured Query Language (SQL) and provides a near-identical user interface (UI) on both a personal digital assistant (PDA) and a desktop computer (PC). Using 'Open DataBase Connectivity' (ODBC, the SQL call-level interface), the desktop program interacts with the database using standard SQL statements. A powerful but simple scripting language implemented in Perl (PC) and C++ (PDA) allows the user to launch SQL statements and manipu-late a graphical user interface in a similar fashion on both PDA and PC. Full source code will be made available under the GNU Public Licence (GPL), including a complete implementation designed for an adult Acute Pain Service.

Dr J.M. van Schalkwyk [MB. BCh(Wits) FCP(SA)(Critical Care) Dip Data(UNISA)] is a Perioperative Physician working in the Departments of Anaesthesia and Medicine at Auckland City Hospital. He is a specialist physician who previously also worked in the field of Intensive Care for ten years. He is also a consultant on the Acute Pain Service at Auckland City Hospital. He is moderately fluent in Perl, C++, SQL, HTML, Javascript, Java, and 80X86 assembly language, and has previously worked in a variety of other languages including Lisp and Z80 assembler. He has some limited experience with digital hardware design, and is utterly hopeless at analogue circuitry. His current interests include clinical teaching and clinical decision making, medical safety, and minimising error in computer operating systems and applications. He and his wife run the website www.anaesthetist.com.

As health information is delivered through technology, security and privacy issues must be addressed. Join Paulo Rocha, Principal Consultant, Brett Roberts, Platform Strategy Manager, Microsoft New Zealand, and invited guests from across the NZ healthcare sector, for a breakfast discussion.

The short presentation on how to coordinate the need for secure and private exchange of healthcare information with the need for collaboration and reduced artificial professional boundaries will be followed by an open forum, to discuss challenges and opportunities across the New Zealand healthcare sector. The discussion will be framed around Microsoft's Trustworthy Computing programme, which was designed to deliver the level of trust and responsibility people expect from the computing industry. Trustworthy Computing focuses on Security, Privacy, Reliability and Business Integrity.

Neil Jordan is Microsoft’s global lead for strategy setting and customer and partner engagement in H&HS; setting direction for the company and working with teams in the local regions as Microsoft and its partners continue to provide technology, solutions and value to its customers in the Healthcare market. He joined Microsoft 5 years ago working in the UK in the Telecoms market and followed his passion back to Healthcare by taking the reigns as the head of the UK Healthcare team three years ago at the start of the ambitions NHS National Programme for IT, leading that team until he moved to Seattle in June of this year. Neil, started his career in Healthcare many years ago through an after-school job building patient record systems for a local Cardiology department in his home town of Bristol in England. Between then and now he gained a BA and MA from Trinity College Cambridge in Biological Anthropology and then worked a 7 year stint with Lotus and then IBM software before joining Microsoft.

For nursing, it is the best of times and the worst of times. Worldwide, there are more nurses and midwives with more training, more applicants for nursing and midwifery education and a growing trend toward creating national-level nursing structures. However, staff shortages, unstable employment, underemployment, nurse migration problems, inadequate career development, low salaries and poor (or worsening) working conditions often counter any positive gains. Increasingly, nursing leaders worldwide accept that only a holistic, multidimensional approach will address the problems in nursing and, by extension, begin to address globalized healthcare itself. The first step in this approach is to embrace information technology as a solution to the many challenges the profession and the industry now face. This presentation will explore the nursing experience in terms of practice perception versus practice reality. It will examine technology’s role in bridging that gap, from educating new nurses and easing the strain of the nursing shortage, to helping practicing nurses improve the safety and ensure the rights of patients. Finally, it will explain how information technology – and nursing’s acceptance of it – will play a key role in the evolution and elevation of the profession, and, by default the whole world of healthcare.

Roy L. Simpson joined Cerner Corporation in February 2000. Mr. Simpson is responsible for strategic sales and planning for the patient care enterprise as well as industry relations related to Cerner’s professional nurse practice. Also, Simpson is a board member of First Hand Foundation which is the philanthropic foundation of Cerner Associates supporting the financial aspects of children’s healthcare globally. Mr. Simpson has more than 30 years of experience in nursing informatics and executive administration. He was a pioneer in the development and funding of the Nursing Minimum Data Set (NMDS).

Mr. Simpson serves on the Board of Trustees for Excelsior College, as adjunct faculty at Vanderbilt University and the University of Kansas Medical Center. Prior to joining Cerner, Mr. Simpson spent more than 13 years with McKesson HBOC and 14 years with Hospital Corporation of America.

Mr. Simpson holds elected fellow status within the American Academy of Nursing, New York Academy of Medicine, and the National Academies of Practice. Mr. Simpson also sits on the Board of Governors and the Executive Committee for the National League for Nursing (NLN). In 2005, Mr. Simpson was elected and will serve as Chair of the Expert Panel on Nursing Informatics for the American Academy of Nursing. Mr. Simpson is contributing editor for three professional journals, culminating in his publishing over 600 articles on nursing informatics.

Many countries including New Zealand are investing significant resources on healthcare information management infrastructures, disease management and integrated care programs. Success of these programs relies heavily on the ability of providers to exchange and analyse data, to produce timely outcome feedbacks. Highly variable data from disparate provider databases make comparative and outcome analysis extremely difficult, with data often “buried” in these “data black-holes”. Problems of poor data usability are highly likely to compromise these programs and result in poor return for the heavy investments. The importance of improving health data quality has been a long sought after goal of the health informatics community and the health care industry.

This project seeks to apply concept analysis techniques from cognitive and mathematic sciences to identify core health data requirements and to develop a standard data structure and reliable transformation rules for healthcare systems. The aim is to develop a collection of standard clinical data to support discharge summary, referral and chronic disease (initially diabetes and cardiovascular diseases) management information interchange.

The proposal has received strong support from the international health informatics community. A multi-national ad hoc data structure standards workgroup has been formed at the 2005 January Health Level 7 workgroup meeting. Initial work has begun with 15 data items being defined and some items transformed into standard archetypical structure. This draft work is currently under view by the international community. Further work will result in the development of an expanded collection of standard clinical data elements, mapping of the data into standard archetypical structure, and generation of UML representation of the archetypes. Significant challenges however exist in harmonizing the clinical data structure with the Health Level 7 RIM classes as these classes contain somewhat less attributes than a comprehensive data element such as the “blood pressure” defined in the initial work.

Data collections or data warehouses are large aggregated data sources. Increasingly, these data collections are being used to inform and drive important decisions within an organization. Because of this increased importance, there is a growing movement to improve the quality of data in these collections. In order to address this data quality for use must be defined. We propose a multi-stage roadmap to data quality. The first stage utilizes theories originating in the data quality movement. A second stage involves development a statement of purpose where the reasons for wanting data quality are explored. Next, data is placed explicitly in its context, ensuring that multiple uses of the same datum are understood as different events. Finally we discuss the importance of integrating learning processes into the information chain in order to maintain data quality taking the decoupled data and explicitly placing it back in its context. This requires a systemic understanding of the 'why structure' embedded in the conceptualisation of a data collection; the intended outcomes and system logic (implicit or explicit theories of action) within the system that the data collection is supporting. We argue that collection data quality will be increased by use of better recognition of the implicit and explicit purpose of such collections to support creation of a learning and knowledge environment that can provide value across those multiple levels of action. These learning models offer a meta-context which provide for the learning processes that will support critical tacit knowledge of those involved in all aspects of the data collection.

Paul Stephenson is a partner in Synergia Ltd, a management consultancy that focuses on public sector strategy. Paul specialises in health sector design and development. Paul has experience in senior health sector policy and management positions in New Zealand and Australia, most recently as State General Manager of Public Health Services and State Director of Child, Community and Primary Care for Western Australia. He was a member of the number of Australian national peak bodies for health sector policy. Paul is currently advising Counties Manukau and Auckland DHBs on major whole-system change projects. He is a member of the Auckland District Health Board Community and Public Health Advisory Committee. Paul has a strong theoretical interest in the application of systems and complexity theories to health sector strategic analysis and design.

Brin Thiedeman has more than twenty fives experience in the information systems and technology industry. Having joined Oracle in December 2002, Brin now occupies the role of Healthcare Business Development Asia Pacific. For the previous ten years he worked in the healthcare sector in Australia and thereby accumulated a wealth of experience and knowledge in many aspects of healthcare information management. Example of his work has included: Development of information system as well as information management strategies with complementary systems and information architectures for hospitals as well as networks of Area or Regional healthcare service providers. Development of healthcare information standards covering primary care (general practice), hospital-based care, ambulatory (clinic-based) care, emergency care, palliative care, community-based care and, coordinated care. Development of the first version of the National Health and Wellbeing Information Model for Australia, a consolidation of all of the other information standards work. Brin has also contributed to some of the foundations for today’s eHealth strategies and policies. For example he led the development of a standard for a Universal Patient Identifier (to be implemented in the State of New South Wales (Australia)). He is also a member of a Standards Australia Committee, contributing towards ongoing development of information standards for Electronic Health Records. Brin is regularly called upon to provide opinion and advice to matters of healthcare information systems strategies to healthcare professionals and administrators at senior levels and is also invited sit on appropriate expert panels and reference groups. He is a regular guest lecturer in Health Informatics on the Master Of Health Science degree course run by the University of Sydney. Brin graduated in Physics at the University of Birmingham and he has post-graduate level education from the University of London.

Electronic systems can replace paper in the distribution, presentation and acknowledgement of laboratory reports, and they can be designed to be intrinsically safer than paper systems. The problem remains of persuading clinicians to use these electronic systems effectively to ensure that significant results do not fall between the cracks.

Ross Boswell is Clinical Director of IT at Middlemore Hospital, where he practices as chemical pathologist and general physician. He has long-standing interests and involvement in bioinformatics and medical informatics. Ross is also currently Chairman of the Board of Censors and of the Chemical Pathology Advisory Committee of the RCPA, and is Chairman of the NZMA.

Vodafone is globally committed to improving health outcomes by mobilizing clinicians, administrators, managers and other health workers. In New Zealand Vodafone invests in a strong partnership program with developers to mobilize health solutions, and also leverages its international mobile health success for the local sector.

This paper describes an innovative three-way alliance of Vodafone, Waikato District Health Board (Waikato DHB), and Orbiz to commercialise a dental clinical mobile solution. The alliance provides a framework for Waikato DHB to further develop DentIS, to extend the solution to other interested DHBs, and to investigate other new clinical mobile applications.

Dr Malcolm Miller is the health sector lead for Vodafone New Zealand Limited, which is part of Vodafone Group Plc and the world's largest mobile community. Malcolm is a medical doctor and has held a number of business management roles in the ICT sector. Vodafone is an international leader in the delivery of mobile health solutions to improve communication with patients and their communities, and to improve the flow of health information for community and hospital health workers.

Present the evidence for the benefits of providing an anticoagulation monitoring service in primary care using Near Patient Testing (NPT) and Computer Decision Support (CDS).

Shows how this model of service provision offers benefits to patients, providers and purchasing authorities.

Dr. David Monks, Experienced GP working in West Auckland and also IT director and practice co-ordinator for the local PHO, HealthWEST. Founding member of HINZ and main interest is improving the value of general practice through IT.

When developing a data warehousing and management reporting strategy it is important to consider not only the technological aspects relating to the task but also the business, information and application perspectives.

This paper introduces an approach, based on the Microsoft Solutions Framework and strategic architecture development methods.

Paulo Rocha is a Principal Consultant based in Auckland, with over 20 years experience in the IT industry covering enterprise architecture planning, systems implementation and team dynamics. He has also extensive experience in software design and implementation, covering line-of business applications and business decision support and process control systems. Paulo coordinates Microsoft Services' involvement in the healthcare industry, strategy consultancy, and he leads the Microsoft Solutions Framework (MSF) activities, being involved with MSF since 1994.Paulo holds a PhD in Computer Science, being an Electronics Engineer with an MSc in Computer Systems. Paulo is also a Microsoft Certified Solutions Developer (MCSD).

Evidence based medicine (EBM) requires appropriate information to be available to clinicians at the point of care. Electronic sources of information may fulfill this need but require a high level of skill to use successfully. This paper describes the rationale and initial testing of a system to allow collaborative searching and rating of information sources for professional groups in the health sector. The approach is based around the use of a browser based on the National library of medicine (NLM) Unified medical language system (UMLS). The range of terms selected and the range of responses generated intricate that such preference recording approaches may be successful. Ontology creation and modification may also be performed by such" information browsers".

David Parry is a Senior Lecturer and PhD student in the AUT School of Computer and Information Sciences. David Parry was awarded a degree in Physics from Imperial College London, followed by a Masters in Medical Physics from St. Bartholomew’s Medical College. More recently he gained a research MSc. In computer science from the University of Otago, New Zealand. His research interests include Internet based knowledge management, health informatics and Information retrieval. Current research projects include the use of Mobile devices in healthcare in a developing nation, the use of radio frequency identification tags (RFID) in operating theatres and fuzzy ontology development and implementation.

Prior to the inception of www.healthpoint.co.nz there was no single access point where the general public and referring doctors could go to get information on specialists or a hospital department or service . Healthpoint's aim is to provide that single access point for doctors, patients and caregivers to source up-to-date, relevant, information about New Zea-land secondary and tertiary medical healthcare services.

The site provides patients with information about what to expect prior to, during and following referral.

Kate Rhind is Managing Director and founder of www.healthpoint.co.nz. Kate has experience in the healthcare sector, as a senior manager for Top 10 multinational pharmaceutical company, Eli Lilly. Her 13 years involvement in the sector includes roles in operations, sales and marketing management, HR, and hospital business unit management.

Paediatricians were surveyed to determine attitudes towards dimensions of an EMR (privacy, confidentiality and security; record content; patients accessing their information, and medical record medium preferences). Attitude statements and one open-ended question were included and a principal components analysis undertaken. 80% reported routine use of computers and 33% rated themselves as being unsophisticated in their use. 74% were concerned that data in the EMR may become corrupted. The same percentage agreed and disagreed that information stored in the EMR will be secure. 69% were concerned that electronic information is open to unauthorised access by persons outside the hospital with 74% concerned about unauthorised access by users within the hospital. 57% agreed that sensitive information should be documented in the EMR. 30% indicated restriction or modification to entries to protect the patient from harm. Equal numbers agreed and disagreed that EMRs will offer the opportunity to communicate more effectively. More than 50% agreed that medical care will be more efficient using an EMR and 67% agreed that computers allow easier access. Variation has been shown in attitudes towards the EMR with doctors indicating concern about patients accessing information and of risks associated with storage of patient information in an EMR.

Julia Logan - BAppSc GradDipHlthSc MAppSc. Head of Department, Patient Information Management Services, Women’s and Children’s Health Service, (formerly King Edward Memorial and Princess Margaret Hospitals). Julia has worked for three tertiary, teaching hospitals in senior management positions since 1990. With a strong interest in the implementation of a paperless record in tertiary hospitals, the focus of Julia’s research has been the perceived and real impact of a paperless record on the privacy, confidentiality and security of patient information. Prior to working in tertiary hospitals Julia was employed as a lecturer in the School of Public Health, Curtin University of Technology, Western Australia. Having recently completed a brief secondment for the Health Reform Implementation Team for the Department of Health in Western Australia, Julia will return from New Zealand to commence a further secondment. The project Julia will oversee is a proposal to introduce a paperless record into a hospital or hospitals in Western Australia.

In 2003 the Ministry of Health and District Health Boards (DHB) jointly commissioned the 2003 Chief Information Officer (CIO) Survey to perform an environmental scan of the current state of information system deployment in the DHBs, to provide a summary report of the challenges and initiatives confronting the CIOs and to provide an inventory of the Information Systems within the health sector [1] The key stakeholders in the 2003 CIO survey were:

1. The Ministry of Health
2. The District Health Board CIOs
3. The DHB Chief Executive Officers (CEO)
The 2003 CIO survey was distributed to all 21 of the DHB CIOs with achievement of a 95% response rate. The 2003 NZ CIO survey collected some useful base data on some of the issues facing the DHB CIOs and identified areas where questions in the electronic questionnaire needed to be reformatted in order to gain more accurate and relevant data. Examples of this are in the staffing section where there was a varied interpretation of the term "FTE" and where the staffing categories, as they were listed, were not easily understood. In the finance section, the questions relating to Information Systems Strategic Plan (ISSP) budget figures, generated feedback from the CIOs indicating that responding to the questions as they were formatted would give misleading data. Discussion amongst the CIO forum group concluded that as the DHB ISSP figures are submitted and held in a central repository, they could be sourced from there and entered into a prepopulated cell in the electronic survey format. They would therefore not need to be supplied by each CIO. The only figures required from the CIOs would be the actual agreed budget figures, which are likely to differ from the estimated ISSP figure.

Barbara O’Shaughnessy studied through Auckland University for Graduate Diploma in Business (Health Informatics) and proceeded to the Master of Health Management (MHMgt) Programme in 2004. The joint Ministry of Health/Auckland University project on the 2003 CIO Survey was also used for the dissertation component of the MHMgt.

Patients with chronic conditions are not well supported by technical systems in managing their conditions. However, such systems could help patients to self-reliantly comply with their treatment. This help could be rendered in the form of alerting patients about condition-relevant issues, transmitting relevant parameters to healthcare providers and analysing these parameters according to guidelines specified by both patients and healthcare staff. If necessary, this analysis of condition parameters triggers the alerting of patients and healthcare providers about actions to be taken.

In this paper, we present the results of a survey we have undertaken to verify and extend requirements we have identified for the design of a Mobile Alerting System for patients with chronic conditions. First of all, the results show that a Mobile Alerting System is desired by patients. Moreover, due to the inter- and intra-user variance of patients and healthcare staff, the system has to work in a context-aware manner and allow for personalised parameters in order to be adaptable to every user's needs.

Doris Jung is undertaking her PhD as a member of the Information Systems and Databases Group of the University of Waikato. Her research interests are Information Systems and Databases (especially Alerting Systems), Health Informatics and Human Computer Interaction. She previously has studied at Freie Universitaet in Berlin where she also worked in the development of software at the Konrad-Zuse-Zentrum and at the Institute of Medical Informatics of the University Hospital Benjamin Franklin.

The New Zealand Family Planning Association (FPA) is a national not-for-profit organization providing sexual and reproductive primary care health services as well as health education, professional training and advocacy on issues of sexual and reproductive health.

Between July 2003 and August 2004 the Clinical Module of Medtech 32, the PMS used by the organisation since 1998, was introduced into 17 Family Planning Clinics throughout the country and 132 (68.6 FTE) doctors and nurses trained in its use.

In late 2004 medical and nursing staff completed a questionnaire providing feedback on their experiences of the introduction process itself, their initial use of the clinical module and their use of it between 3-15 months later.

This paper describes the preparation for introduction of the clinical module, the introduction process itself, problems and pitfalls encountered and doctors and nurses perceptions of the introduction and subsequent use in their daily clinical practice. Future plans for the use of the PMS within FPA are briefly discussed.

Helen MacKenzie has been National Project Manager for the NZ Family Planning Association for the past 2 years and was previously Manager of Clinical Services for the Northern Region of FPA since 1993, based in Auckland. She has a nursing background and her particular areas of interest are health services for women, the use of information and communication technology in the delivery of primary health care and the management of primary health care services

Simpl and Hutt Valley District Health Board (HVDHB) partnered to provide a flexible, easily deployable Schools Based Vaccination System (SBVS) for the Ministry of Health (MOH). The system imports school rolls and manages the information surrounding the meningococcal vaccination campaign for each District Health Board (DHB). SBVS is an approved provider of immunisation information to the National Immunisation Register at the MOH. Timing of the campaign and the need for the system to support this were challenges to the project. The success was based on the true partnership exercised by those involved, public and private and the sense of a single team!

The current policies of the governments of Australia and New Zealand encourage the use of electronic information systems to exchange patient information between various stakeholders. However, little research has been undertaken to investigate the attitudes of patients toward sharing their medical information. This paper presents the findings of a questionnaire survey of the attitudes of adult primary-care patients towards the distribution of their medical information. Over 200 responses were collected from five clinics Patients were found to be very poorly informed about the use of their information, 90% of respondents indicated that they had incompleteor no knowledge of how their information was shared and 79% had no knowledge of the uses of their National Health Index (NHI) number.

Patient attitudes toward sharing their information were found to be influenced by two factors: 1. Anonymity, patients are more prepared to share anonymous information. 2 Recipient, whilst patients are willing to have their information shared between healthcare professionals, they are increasingly unwilling for it to be distributed to other stakeholders, such as administrators, researchers or other government departments. The findings also indicate that patients would prefer to be consulted about the distribution of their information.

Errors in the administration of drugs to patients, along with other types of adverse drug events (ADEs), have proven to be very costly to the healthcare sector. One commonly proposed solution to the problem is the use of barcodes to uniquely identify both patients and drugs. The size of the ADE problem, and the success of a limited number of barcode-based systems, has prompted US healthcare regulators to endorse, or even mandate, their use. However, it has been suggested that limitations of barcodes adversely affect the usability of such systems, and that RFID technology offers a more suitable alternative.

This paper documents the design and development of an extension to an existing barcode-based anaesthetic drug identification system, IDAS, which would allow it to functionally replace barcodes with RFID technology. The design is informed by a review of RFID application case studies, experiments with RFID hardware, and observation and interviews of anaesthetists. A demonstration of the prototype system suggests that RFID technology could functionally replace barcodes, but significant issues remain to be addressed.

Bryan Houliston has a Bachelors degree in Commerce, and recently completed a Masters in Information Technology. In between he worked for 11 years in software development. Bryan has a long-standing interest in wireless technology, but this paper represents his first foray into health informatics.

This short paper gives an overview of the process of integration of the Ascot and Mercy Hospitals, including, information management, connectivity, change management, culture shifts, and attitudes and feelings. We will describe some of the challenges faced during the integration, the way in which these challenges were met and the authors' views on how this process could have been made easier.

Kirsten Biggs is a Registered Comprehensive Nurse and has worked in the Operating Rooms for 11 years. In 1998 she joined the Ascot hospital project team to help set up the Theatre Suite where she remained as Charge Nurse of General Surgery until February 2002, during this time she also worked as part of the I.T. team trouble shooting and training staff in clinical applications. Kirsten took a year off on Maternity Leave, and when she returned applied for a newly created position "Clinical I.S. support" within the I.T. department. Kirsten retains this position where she liaises between clinical staff and the I.T. team, and is involved in project management, clinical application training, and Database analysis.

Health administrative costs are excessive and divert resources from better health outcomes. One important approach to reducing these costs is process automation, an approach which has improved administrative costs in the insurance sector by a large margin.

This paper discusses these issues from an anecdotal perspective, drawing on the experiences of Idiom Ltd. Health has some domain specific factors which have made process automation more difficult when compared to some other sectors, particularly with regard to the number of process participants. The corollary is that when we resolve these factors, then the efficiency rewards that will be derived (from successful process automation) will be that much greater.

We suggest that 'decisioning' is an important new concept that will be critical to achieving process automation. While relatively new, this technology is current and available, and already has a number of early adopters in the health sector.