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Across the world, bodies representing health informatics or promoting health informatics are either societies of common interest or universities with health informatics courses/departments. Professional colleges in Health Informatics (similar to the idea of professional colleges in other health fields) are few and far between. The Australasian College of Health Informatics has been in existence since 2001, and has an increasing membership of nearly 100 fellows and members, acting as a national focal point for the promotion of Health Informatics in Australasia. Describing the activities of the college, this article demonstrates a need for increasing professionalization of Health informatics beyond the current structures.

Data quality plays a very important role in predicting clinical outcomes. Data quality is multi dimensional and most relevant studies consider just one or two dimensions. In this study a systematic data quality assessment is performed using four data dimensions. The results demonstrate that performance of predictive models improves when the quality of the data is assessed and addressed systematically.

Background: Information in Electronic Health Records (EHRs) are being promoted for use in clinical decision support, patient registers, measurement and improvement of integration and quality of care, and translational research. To do this EHR-derived data product creators need to logically integrate patient data with information and knowledge from diverse sources and contexts., Objective: To examine the accuracy of an ontological multi-attribute approach to create a Type 2 Diabetes Mellitus (T2DM) register to support integrated care., Methods: Guided by Australian best practice guidelines, the T2DM diagnosis and management ontology was conceptualized, contextualized and validated by clinicians; it was then specified, formalized and implemented. The algorithm was standardized against the domain ontology in SNOMED CT-AU. Accuracy of the implementation was measured in 4 datasets of varying sizes (927-12,057 patients) and an integrated dataset (23,793 patients). Results were cross-checked with sensitivity and specificity calculated with 95% confidence intervals., Results: Incrementally integrating Reason for Visit (RFV), medication (Rx), and pathology in the algorithm identified nearly100% of T2DM cases. Incrementally integrating the four datasets improved accuracy; controlling for sample size, data incompleteness and duplicates. Manual validation confirmed the accuracy of the algorithm., Conclusion: Integrating multiple data elements within an EHR using ontology-based case-finding algorithms can improve the accuracy of the diagnosis and compensate for suboptimal data quality, and hence creating a dataset that is more fit-for-purpose. This clinical and pragmatic application of ontologies to EHR data improves the integration of data and the potential for better use of data to improve the quality of care., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Improving healthcare for people with chronic conditions requires clinical information systems that support integrated care and information exchange, emphasizing a semantic approach to support multiple and disparate Electronic Health Records (EHRs). Using a literature review, the Australian National Guidelines for Type 2 Diabetes Mellitus (T2DM), SNOMED-CT-AU and input from health professionals, we developed a Diabetes Mellitus Ontology (DMO) to diagnose and manage patients with diabetes. This paper describes the manual validation of the DMO-based approach using real world EHR data from a general practice (n=908 active patients) participating in the electronic Practice Based Research Network (ePBRN)., Method: The DMO-based algorithm to query, using Semantic Protocol and RDF Query Language (SPARQL), the structured fields in the ePBRN data repository were iteratively tested and refined. The accuracy of the final DMO-based algorithm was validated with a manual audit of the general practice EHR. Contingency tables were prepared and Sensitivity and Specificity (accuracy) of the algorithm to diagnose T2DM measured, using the T2DM cases found by manual EHR audit as the gold standard. Accuracy was determined with three attributes - reason for visit (RFV), medication (Rx) and pathology (path) - singly and in combination., Results: The Sensitivity and Specificity of the algorithm were 100% and 99.88% with RFV; 96.55% and 98.97% with Rx; and 15.6% and 98.92% with Path. This suggests that Rx and Path data were not as complete or correct as the RFV for this general practice, which kept its RFV information complete and current for diabetes. However, the completeness is good enough for this purpose as confirmed by the very small relative deterioration of the accuracy (Sensitivity and Specificity of 97.67% and 99.18%) when calculated for the combination of RFV, Rx and Path. The manual EHR audit suggested that the accuracy of the algorithm was influenced by data quality such as incorrect data due to mistaken units of measurement and unavailable data due to non-documentation or documented in the wrong place or progress notes, problems with data extraction, encryption and data management errors., Conclusion: This DMO-based algorithm is sufficiently accurate to support a semantic approach, using the RFV, Rx and Path to define patients with T2DM from EHR data. However, the accuracy can be compromised by incomplete or incorrect data. The extent of compromise requires further study, using ontology-based and other approaches., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Disease registries derived from Electronic Health Records (EHRs) are widely used for chronic disease management (CDM). However, unlike national registries which are specialised data collections, they are usually specific to an EHR or organization such as a medical home. We approached registries from the perspective of integrated care in a health neighbourhood, considering data quality issues such as semantic interoperability (consistency), accuracy, completeness and duplication. Our proposition is that a realist ontological approach is required to systematically and accurately identify patients in an EHR or data repository of EHRs, assess intrinsic data quality and fitness for use by members of the multidisciplinary integrated care team. We report on this approach as applied to routinely collected data in an electronic practice based research network in Australia.

Introduction: Increasing investment in eHealth aims to improve cost effectiveness and safety of care. Data extraction and aggregation can create new data products to improve professional practice and provide feedback to improve the quality of source data. A previous systematic review concluded that locally relevant clinical indicators and use of clinical record systems could support clinical governance. We aimed to extend and update the review with a theoretical framework., Methods: We searched PubMed, Medline, Web of Science, ABI Inform (Proquest) and Business Source Premier (EBSCO) using the terms curation, information ecosystem, data quality management (DQM), data governance, information governance (IG) and data stewardship. We focused on and analysed the scope of DQM and IG processes, theoretical frameworks, and determinants of the processing, quality assurance, presentation and sharing of data across the enterprise., Findings: There are good theoretical reasons for integrated governance, but there is variable alignment of DQM, IG and health system objectives across the health enterprise. Ethical constraints exist that require health information ecosystems to process data in ways that are aligned with improving health and system efficiency and ensuring patient safety. Despite an increasingly 'big-data' environment, DQM and IG in health services are still fragmented across the data production cycle. We extend current work on DQM and IG with a theoretical framework for integrated IG across the data cycle., Conclusions: The dimensions of this theory-based framework would require testing with qualitative and quantitative studies to examine the applicability and utility, along with an evaluation of its impact on data quality across the health enterprise.

Disease registries derived from Electronic Health Records (EHRs) are widely used for chronic disease management. We approached registries from the perspective of integrated care in a health neighbourhood, considering data quality issues such as semantic interoperability (consistency), accuracy, completeness and duplication. Our proposition is that a realist ontological approach is required to accurately identify patients in an EHR or data repository, assess data quality and fitness for use by the multidisciplinary integrated care team. We report on this approach with routinely collected data in a practice based research network in Australia.

Background: The increasing use of routinely collected data in electronic health record (EHR) systems for business analytics, quality improvement and research requires an extraction process fit for purpose. Little is known about the quality of EHR data extracts. We examined the accuracy of three data extraction tools (DETs) with two EHR systems in Australia., Methods: The hardware, software environment and extraction instructions were kept the same for the extraction of relevant demographic and clinical data for all active patients with diabetes. The counts of identified patients and their demographic and clinical information were compared by EHR and DET., Results: The DETs identified different numbers of diabetics and measures of quality of care under the same conditions., Discussion: Current DETs are not reliable and potentially unsafe. Proprietary EHRs and DETs must support transparency and independent testing with standardised queries. Quality control within an appropriate policy and legislative environment is essential.

Background: Many studies have shown the effectiveness of self-management for patients with asthma. In particular, possession and use of a written asthma action plan provided by a doctor has shown to significantly improve patients' asthma control. Yet, uptake of a written asthma action plan and preventative asthma management is low in the community, especially amongst adults., Objective: A Web-based personally controlled health management system (PCHMS) called Healthy.me will be evaluated in a 2010 CONSORT-compliant 2-group (static websites verse PCHMS) parallel randomized controlled trial (RCT) (allocation ratio 1:1)., Methods: The PCHMS integrates an untethered personal health record with consumer care pathways and social forums. After eligibility assessment, a sample of 300 adult patients with moderate persistent asthma will be randomly assigned to one of these arms. After 12 months of using either Healthy.me or information websites (usual care arm), a post-study assessment will be conducted., Results: The primary outcome measure is possession of or revision of an asthma action plan during the study. Secondary outcome measures include: (1) adherence to the asthma action plan, (2) rate of planned and unplanned visits to healthcare providers for asthma issues, (3) usage patterns of Healthy.me and attrition rates, (4) asthma control and asthma exacerbation scores, and (5) impact of asthma on life and competing demands, and days lost from work., Conclusions: This RCT will provide insights into whether access to an online PCHMS will improve uptake of a written asthma action plan and preventative asthma actions., Trial Registration: Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000716864; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362714 (Archived by WebCite at http://www.webcitation.org/6IYBJGRnW).

The National Health and Medical Research Council (NHMRC) Harmonisation of Multicentre Ethical Review (HoMER) project aims to implement a 'single ethical review', where the outcome of an ethical and scientific review by a single recognised Human Research Ethics Committee (HREC) will enable multiple institutions to decide whether or not to participate in a given study. The desired process will include agreement on time frames, authority of the reviewing HREC, respect among the jurisdictions, verification by independent organisations, and compliance with the national statement and relevant statutory and administrative frameworks. However, there appears to be little discourse on the implications for general practice research in the research community.

The practice-based research network (PBRN) is a resource to recruit research participants; conduct developmental and pilot studies; and coordinate multicentre research, teaching, clinical care and quality assurance programs. It is a community-based laboratory for translational, clinical and health services research. The mining of clinical information systems of PBRNs can be used to monitor performance at the service unit level. However, are the routinely collected data of ePBRNs fit for the abovementioned purposes? We describe the establishment and governance of an ePBRN which included general practice and community health and hospital units, The general practice data quality was examined, using diabetes as the context, for completeness, correctness and consistency and assessed on its fitness for research, audit and quality assurance purposes. The quality of social determinants data was generally good while risk factors data were variable. Issues and strategies for improving data quality are discussed.

Current Australian health, hospital and primary care reforms, emphasise e-health strategies, including online communities and the electronic Person Controlled Health Record (ePCHR), as a means to improving patient support and self management of chronic disease. However, the benefits and risks of these tools to general practice are poorly understood.

Background: The translation of molecular medicine into clinical practice has implications for general practice and personalised medicine., Objective: This article outlines requirements for general practice to make optimal use of genomics., Discussion: Genomics identifies variations in many genes, enhancing knowledge of gene-gene and gene-environment interactions. Unlike personal information, genomic information raises issues of privacy, potential family trauma and discrimination by employers and insurers. To embed genomics safely and effectively into practice, general practitioners need information, competencies and support through regulation, policy, information management, professional decision support, patient self management, community engagement and educational activities.

This chapter gives an educational overview of: * health informatics competencies in medical, nursing and allied clinical health professions * health informatics learning cultures and just-in-time health informatics training in clinical work settings * major considerations in selecting or developing health informatics education and training programs for local implementation * using elearning effectively to meet the objectives of health informatics education.

This chapter gives an educational overview of: * Evidence for the benefits of CDSS; * Categories of CDSS including user and workflow requirements; * A framework for the implementation of CDSS, including human factors and the problem of free text; * a framework for the evaluation of CDSS.

This chapter gives an educational overview of: * The elements of a clinical decision; * The elements of decision making: prior probability, evidence (likelihood), posterior probability, actions, utility (value); * A framework for decision making, and support, encompassing validity, utility, importance and certainty; and * The required elements of a clinical decision support system. * The role of knowledge management in the construction and maintenance of clinical decision support.

This chapter gives an educational overview of: * The biopsychosocial model of primary health care and longitudinal relationships; * Management of undifferentiated problems and chronic illness within the clinical relationship; * Patient-centred care in the context of health promotion, early detection and effective care of patients with chronic illness; * Inter-professional networks, connectedness, connectivity and interoperability; * Record linkage and health information sharing/exchange for clinical, audit, quality assurance, professional development and research purposes.

The Australian National Medicines Policy embodies four tenets: availability, quality, safety and efficacy of medicines; timely access to affordable medicines; quality use of medicines (QUM); and a responsible and viable medicines industry. The promotion of QUM requires a multidisciplinary approach, including contributions from government, the pharmaceutical industry, health professionals, consumers and academia. However, there are significant tensions and unintended effects associated with the multidisciplinary approach, especially with the relationships between prescribers and dispensers of medicines. The general practitioner and the pharmacist share a common ancestor - the apothecary. The separation of dispensing from prescribing, which began in medieval Europe and 19th century England, reframed and confined the patient-doctor relationship to one of diagnosis, prescription and non-drug management. The role of pharmacists was limited to dispensing, though the present trend is for their responsibilities to be widened. Historical antecedents, the contribution of an increasing number of actors to the costs of health care, universal health insurance and an evolving regulatory framework, are among the factors influencing doctor-pharmacist relations. The prescribing and dispensing of medicines must be guided by an ethical clinical governance structure encompassing health professionals, regulators, the pharmaceutical industry and consumers. There must be close monitoring of safety and effectiveness, and promotion of quality use of medicines and improved patient outcomes. Ongoing training and professional development, within and across professional boundaries, is essential to support harmonious and cost-effective inter-professional practice. The approach must be "apothecarial" with complementary roles and responsibilities for the prescriber and dispenser within the patient-clinician therapeutic relationship, and not adversarial.

eConsulting, in all its contexts, can promote and improve the amount and quality of services and knowledge transferred to and among the community of health care providers and consumers. It can also improve the efficiency and effectiveness of the specialist and generalist workforce and accessibility to the services provided. This chapter defines eConsulting, provides the context, and introduces a conceptual framework to describe its current practice and future possibilities. A clinical scenario of a patient with a breast lump is used to ground the molecular, clinical, organizational, and social, legal, and ethical issues in real world practice. The approach/method used is based on the clinical process, evidence-based practice, and appraising the quality, validity, relevance, and usefulness of the information. The practicalities and utility of current eConsulting tools are discussed with a view to future ubiquitous use. Working through this chapter should assist readers to understand and describe (1) how eConsultations can link and translate scientific research into clinical practice, (2) the current implications of eConsultations, (3) the future potential of eConsultations.

Aim: To examine the perceptions, knowledge and reported intended practice of prostate cancer screening by general practice registrars., Method: A descriptive study using a mail survey of all Victorian general practice registrars and supplementary interviews., Results: The response rate to the questionnaire was 74% (n = 148). The reported correct answer for the sensitivity and specificity of digital rectal examination (DRE) and prostate specific antigen (PSA) test was 48% and 52%, and 30% and 35% respectively. Responses to questions about registrar's knowledge of screening guidelines indicated respondents believe that men aged 50 years and over should undergo annual screening. Over 50% of respondents were not familiar with any Australian guidelines for prostate cancer screening. However, reported intended practice was consistent with guidelines, with 73% of respondents indicating they would not perform a PSA test as part of a 55 year old man's check up. Qualitative interviews highlighted the importance of The Royal Australian College of General Practitioners supervisor, peer learning at release sessions, and study group preparation for college examination in their clinical decision making. Online learning and access were seen to be potential areas for further development., Discussion: While knowledge about the characteristics of tests for prostate cancer and Australian prostate screening guidelines is poor, most registrars practice according to current guidelines. The potential of online learning and increased access to the internet needs further study.

Background: 'Standards' refer to common standards for communication and exchange of information about goods and services. Embedded within these common standards are gold standards for quality, privacy, safety and performance. Technical and semantic standards are essential building blocks for the required information and communication infrastructure to support the secure management and sharing of high quality information across general practice and the health care system., Objective: To describe the current developments and implications of terminology, architecture and messaging standards in general practice., Conclusion: The current Health Online framework and National Health Information Standards Plan, with nationally coordinated implementation strategies like HealthConnect and the Better Medication Management System, are encouraging, However, there is little common understanding of technical and semantic standards among clinicians, administrators and researchers in general practice and health care system. The state-Commonwealth and private-public dichotomies are other barriers. As part of their roles as gate-openers in an integrated health care system, GPs must explicitly promote the implementation of national communication and information exchange standards.