Other hospitals such as St Vincent's and Mater Hospitals have been able to able to make the most of existing core competency -- in its case, writing software. The hospitals' CIO, David Roffe, says having these skills has allowed the utilisation of open source applications and tools -- such as the J-box open source Web application server and content management system Joomla -- to create its own electronic patient record.

"We're an application and development house, which is unique in Australia," he says. "There are four people in the development team and we have 32 IT staff to look after three hospitals: St Vincent's Public and two private -- St Vincent's Private and the Mater Hospital in North Sydney. We're a shared service; we provide those services across those three hospitals from a single IT department based in Darlinghurst." Further suggesting how far hospitals are ahead of the curve, Roffe says St Vincent's Private and the Mater Hospital have had an electronic medical record system for the past decade and a half.

"Everything a nurse has done in a private hospital has been electronic for 15 years and that same system is moving into the public as we speak," he says. "We've been making that transition for about eight years.

Like CHW's Vargas, Roffe stresses there are challenges, particularly around change management among senior medical staff -- read: older doctors reluctant to change their ways -- but younger staff are embracing change.

"The junior doctors just eat this stuff up and that's what we provide for them, but the senior doctors don't type, so if you put a clinical system in front of them that's electronic, they don't want to feel disenfranchised in front of the junior people," he says. "The junior people tend to do more of the work; it's a generational thing. The junior doctors interact with the system; for the senior doctors we provide view access so they know what's in it but they don't like to type so the junior doctors do it all for them."