Adams, D (2001). Palm link for home care's helping hands. Fairfax Interaction Network - ITnews: 1-3.

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Two Victorian councils are to trial the use of Palm Pilots to try to streamline the provision of home care services to the aged and disabled.
SurfLink, the Torquay-based business unit of the Surf Coast Shire, is working in conjunction with Geelong-based software development company Icon Global Solutions to enable Palm Pilots to be used by home carers in an effort to reduce the paperwork and time that council staff spend on administration.
Under the trial, to take place in the areas of both Surf Coast Shire and Moreland City Council, home carers will use the Palm Pilot to scan a barcode placed somewhere inside the home of a client when they visit.
The Palm Pilot, which in the initial stages will contain only limited client and roster details, will automatically record the time of a carer's visit and provide a facility for them to tick off those services they perform.
The client will then sign the Palm Pilot and the information will be later downloaded to the municipal computers.
SurfLink envisage it will eventually be able to download complete client records to the Palm Pilots and remotely send carers' assessments back to a central computer.
The trial follows the development of CareLink - a software package for councils to electronically manage their provision of home care.
Created over 18 months by Icon, in conjunction with staff at SurfLink, the software package has so far been taken up by several councils across the state including Moreland, Mount Alexander and Mornington Peninsula.
Private sector home care companies such as Care at Home and Australian Home Care Services - the business unit of the MS Society - are also using the system.
The councils and businesses pay an initial capital cost and then an annual sum for licensing and maintenance.
SurfLink has since developed a software package known as IT Works for managing council maintenance programs and a strategic asset management system known as Asset Manager.
"We took the view that if we needed these products as local government services providers then why wouldn't the rest of Victoria or Australia need these products as well?" said Michael Courtney, general manager of SurfLink Corporate Services.
Debbie Street, CareLink account manager, said the CareLink software enabled the shire to keep a single record for each home care client and could match a carer with a past client at the touch of a button instead of spending time searching paper records.
Street said that in addition to the central package, customers can add modules - that cover such things as meals on wheels, transport or home maintenance services - to the system as they require.
CareLink also automatically manages government reporting requirements as well as rosters and timesheets, reducing the time it takes to work out the carers' payroll from a couple of days to 20 minutes.
"There are no manual processes at all," Courtney said. The CareLink system has been estimated to cut the time spent on rostering and administration by 70 per cent.
While the Surf Coast has about 300 home care clients and 40 home care staff, Courtney said the real benefits of the system can be found in some larger councils that can have several thousand clients and several hundred carers.
As well as providing the technical expertise needed to create the software packages, Icon also provides technical support for customers online via e-mail.
Icon was founded in 1996 and specialises in providing software solutions to the food and transport industries as well as local government. Its clients include CSL, Cadbury Schweppes, SPC and the CSIRO.
Craig Porte, Icon's commercial director, said the company - which had also developed hand-held applications in regard to IT Works and Asset Manager - has entered into a partnership with Symbol Technologies to supply the Palm Pilots.
The CareLink Palm Pilot trial will use a SPT 1500 Palm Pilot with barcode scanner, a capacity of 2MB of RAM and a Windows CE or Palm operating system.
Courtney said that while the use of the Palm Pilots would make the whole process "virtually paperless", there was also a public education aspect that needed to be addressed.
"You're dealing with elderly persons, you're dealing with people who probably aren't 100 per cent comfortable with technology, so it's about leading that process in," he said.
Courtney added that the organisations themselves need to go through a cultural change.
"I think one of our challenges is even to get our existing clients to use its full potential."

Bolsin, S (2001). Personal professional monitoring: The ANZCA / UMP palm pilot project. Demystifying Risk Management and Clinical Governance, Canberra.

Presentation at the ARCHI Tool Kit Seminar "Demystifying Risk Management and Clinical Governance", 10/4/01.

Celler, B, Lovell, N, et al. (1999). "The potential impact of home telecare on clinical practice." Medical Journal of Australia 171: 518-21.

Home telecare is the use of information, communications, measurement and monitoring technologies to evaluate health status and deliver healthcare from a distance to patients at home (Box, Figure 1). In the United States, home healthcare is the fastest-growing healthcare delivery sector1,8 -- more than 5.9 million Americans received home healthcare services valued at more than $US25 billion in 1996. Only about 50 of almost 1800 US home care agencies are currently active in home telecare, but, driven by changes in healthcare provision and reimbursement policies, many more are participating in trials of cost effectiveness; home telecare is expected to grow dramatically.
Outside the US, the move towards telecare is being driven by the acceptance that national health services have a responsibility to manage the needs of an ageing population.2,9,10 People aged 65 years and over now represent 12% of the Australian population,11 a figure which will increase to 25% by 2051. Furthermore, average healthcare expenditure per person is currently $2536 per year, but increases almost tenfold for those aged 75 years and over.
The increasing cost of providing healthcare services to an ageing population and changing patterns of use of hospital resources (a rise in admissions but a fall in the average length of stay) are powerful forces for shifting the focus of care from the hospital to the home.

Landro, L (2001). Emergency rooms hope new technology will ease their traumas. Wall Street Journal. New York: B1.

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Patients having to visit emergency rooms these days may face more than medical worries. Physicians warn that the nation's nearly 5,000 hospital ERs are operating at critical capacity, and are often forced to turn away patients and divert ambulances to other locations.
"Most Americans still have no idea how dangerous it has become to be ill or injured at the wrong time," says Todd Taylor, an emergency physician in Arizona, where ER doctors recently declared they had "lost confidence" in the emergency-care system.
The crisis is a result of several health-care problems with no easy fix: millions of uninsured patients who use emergency facilities for primary care, nursing shortages, hospital closings and Medicare cuts .
Many ERs are turning to technology for help. They are using Web-based systems to reroute ambulances, and are adopting computer programs to create "paperless" emergency rooms and manage flow so patients aren't backed up on gurneys awaiting a bed.
The American College of Emergency Physicians says the number of ERs with Internet access has doubled each year over the past two years, helping hospitals break bottlenecks and instantly access lab tests, X-rays and medical data. But many ERs still rely on 1950s technology, "with barely legible scribbled charts and records on microfilm," says Robert W. Schafermeyer, president of the organization.
"You have to wonder why, if the hotel industry can tell you to the minute when a bed is open and clean, why hospitals can't do the same," adds William Cordell, director of Emergency Medical Research and Informatics at Methodist Hospital in Indianapolis and a professor at the Indiana University School of Medicine.
His hospital already uses a wireless system to register emergency patients at bedside and a "radar screen" tracking system in its ER. The program, designed by Cincinnati-based New Wave Software, tracks the location of patients, staff, carts and equipment. New Wave this July will begin marketing an off-the-shelf program for about $2,500 that ERs can install on exiting computer systems. The company also is working on small clip-on devices and wall-mounted or ceiling-mounted sensors that will automatically record all this information.
In one major initiative, more than 100 hospitals have been working with the Boston-based nonprofit Institute for Healthcare Improvement to reinvent the way emergency departments operate. Donald Berwick, chairman of IHI, says hospitals must approach patient flow the way industrial companies manage engineering and process-improvement programs, including creating scheduling models to anticipate care needs. "You don't wait to react, but do some proactive planning to get ready for demand," Dr. Berwick says.
IHI has enlisted Medical Director James Espinosa and Chief Nursing Officer Linda Kosnick at Atlantic Health System's Overlook Hospital in Summit, N.J., to field test patient-tracking systems. One goal is to cut to less than 90 minutes the time it takes from making a decision to admit a patient to transferring that patient to a bed. Computers display on a single screen the status of eight critical steps in the admitting and treatment process, and every 15 minutes flash reports on how well the ER is performing against its time goals.
If the goals aren't met, an "intervention" clicks in. In a worst-case "red" scenario, for example, the ER is at 150% occupancy with no available hall space, with a two-hour wait to see a doctor and all other area hospitals on divert status. The system would automatically alert top hospital
officials, notify other hospital departments, increase the number of lab and radiology workers and delay all elective surgeries for the moment.
"Eventually this should be imbedded in all hospital information systems," says Dr. Espinosa.
The Overlook Group found that "fast track" systems work best for minor-emergency patients, who account for 30-50% of total visits. But because surveys show patients sometimes feel rushed, the visits should take at least 40 minutes but less than an hour.
At Boston's Beth Israel Deaconess Medical Center, emergency physician John Halamka, chief information officer for parent CareGroup, found that most delays occurred between the decision to admit a patient to the hospital and discharge from the ER to a hospital bed. So in a new state-of-the art ER opened this month, an electronic wall, known as the "dashboard," shows the status of every patient, their time in the emergency department, the availability of a hospital bed, test results and the capacity status of the entire department - all on five-foot screens. The hospital's own secure medical-record system, CareWeb, provides the lab, radiology and EKG results.
About 250 hospitals in 16 U.S. cities are now using Infinity Healthcare's EMSystem, a program developed by Milwaukee emergency physician Chris Felton. The Web-based system tracks bed availability and diversions in metropolitan areas, communicating directly to ambulances via wireless technology, e-mail paging and even direct Internet connections.
While Dr. Felton says it can stem the tide of ER overcrowding, such programs are a band-aid until the emergency system's bigger problems can be resolved. "Diversion itself is a symptom of a much greater ill," he says.

Manitoba Centre for Health Policy and Evaluation (2001). Using the Manitoba Hospital Management Information System: Comparing Average Cost Per Weighted Case and Financial Ratios of Manitoba Hospitals. Manitoba, University of Manitoba: 1-139.

MIS is the national statistical and financial reporting system recently adopted by Manitoba hospitals. This feasibility study explored the issues in using MIS data to estimate the average cost of providing inpatient care.

Mount, C, Kelman, C, et al. (2000). "An integrated electronic health record and information system for Australia?" Medical Journal of Australia 172: 25-7.

It is almost 100 years since the introduction of the "unit record" at St Mary's Hospital in 1907 marked the beginning of the modern medical record. The centenary would be an appropriate target date for the full implementation in Australia of a national Integrated Health Record and Information System (IHRIS) which goes beyond existing institution-based, sector-based or system-based records to cover all contacts with the healthcare system. In 1997, the House of Representatives report Health on Line recommended the development and deployment of such a system. The idea of an integrated national approach has been endorsed by the UK National Health Service information policy. It includes plans to create a lifelong electronic health record by 2005. The New Zealand Health Department is well advanced in the implementation of an integrated health record system, and a number of healthcare funding bodies in the United States have introduced comprehensive electronic health records and information systems.
Here, we present the case for a national system, as recommended by the House of Representatives report. Our views have been strongly influenced by a series of multidisciplinary forums which we convened to explore the proposal.