Significant [unsung] progress in Australia’s ehealth

by Charles Wright on November 29, 2011

Developers of GP desktop software working on NEHTA’s vendor panel expect the authority to be able to make a series of positive announcements in the early part of next year, as they make steady progress on key elements of the infrastructure needed to launch the nation’s ehealth revolution.

With most of the industry’s attention focused on a single project which will allow the easy transmission of a shared health summary for the PCEHR – due to be launched on July 1 next year – the parallel development of code that will allow secure messaging between practitioners, electronic referrals from GPs to specialists and allied health professionals and electronic transfer of prescriptions in an open, seamless format will take the public, most clinicians and even members of the software industry by surprise when it is unveiled at roughly the same time.

One industry veteran says the work will clear the barriers that have held up seamless, nation-wide clinical communications and electronic health records “for the past 15 years”.

“People don’t seem to be aware of the fact that we are implementing everything NEHTA has come up with over the past five years – basically their concept of how it all hangs together.

“We are doing very good work that has been needed for a long time, but nobody has been prepared in the the past to sit down and make it work properly. We have had some ability to send e-referrals and e-prescriptions, but everything has been cobbled together with various work-arounds that make it very fragile and unnecessarily complex.

“We’ve been using horrible formats like HL7 V2 which is documented, but too flexible, so that you still have messages that one system can generate and another system can’t read. The result is that we have clinicians having to install five or six messaging clients, because each message has to have the same client at each end to be able to parse them. That means in practice it’s a comparatively rare event.

“We’ve also been held back by the lack of unique patient identifiers and coding systems for drugs and diagnosis. Now all of that stuff is finally starting to happen.

“The work we are doing now is nailing everything down so that everyone knows exactly how to interpret the messages. It’s using strictly defined CDA (Clinical Document Architecture) along with AMT for drug coding and SNOMED CT-AU for diagnosis coding, and it’s going to make things universal and interoperable. This is really good work that we would never have bothered doing if NEHTA hadn’t funded us to do it because there was no real demand from users.”

By August developers of Best Practice, Zedmed, iSoft and Medtech, who are on the panel, had met the specifications to make their software compatible with the Individual Health Identifiers introduced last year, and capable of displaying hospital discharge summaries and specialist letters in a CDA browser.

The next phase, adding the ability for a GP to press a button in their software and automatically generate a summary of a patient’s record and upload it to conformant repositories – initially most of the Wave 2 testing sites but eventually to a patient’s PCEHR – and also to send CDA compliant ereferrals, was originally scheduled for completion by tomorrow. The deadline for that work – arguably the most complex part of the project – has been extended to January 30, although I understand some developers expect to have coding completed well before then.

Each application will take a different approach to the presentation of the various pieces of patient data – including adverse reactions and allergies, current medications, past medical history and immunisations –  to the GP for selection and transmission, but the emphasis for all is to simplify the procedure to a matter of ticking boxes.

Ultimately the software will generate an events summary, or record of a single consultation, which the GP will be able to send to the PCEHR at the end of each patient visit – if they consent – with any changes to medication or past history.

One industry observer says the significant progress in ehealth development has been deliberately overlooked by the Medical Software Industry Association, many of whose members develop software outside the primary care environment targetted by the PCEHR.

“The MSIA has been very negative, basically because I think they got their noses out of joint. There were a lot of people who created an uproar last year because they thought there would be a lot of money going to people involved in GP software and the rest, who sell applications for pharmacists and aged care etc., were going to miss out. At the end of the day that’s what did happen, because pharmacy software for instance isn’t any help if what you want to do is upload a healthcare summary to a PCEHR.”

He suggests some senior members of the MSIA felt NEHTA had not consulted them sufficiently. “That’s probably true,” he said, “but the positives that are going to come out of this work are so significant that the MSIA should be publicly supporting it, rather than generating bad publicity all the time.”

He says he is waiting to see if some recent changes on the MSIA’s committee produce a more positive approach.


{ 1 comment }

Keith July 12, 2012 at 9:44 pm

So what happened to all of this unsung progress which was so imminent in November last year and seems so far from happening almost eight months later? It would indeed be great to have universal secure messaging across all of the common clinical and messaging systems. It would be great to have e-referrals, e-discharge summaries and e-specialist reports, replacing the slow delivery of paper versions, and eliminating the need to scan and file hundreds of thousands of paper letters. It would be great to have a standards-compliant e-prescription service in place, reducing errors, wastage and “doctor-shopping” for drugs. But I don’t see any prospect of these things happening any time soon.

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