Andrew McIntyre wrote: > Hello All, > > some comments on a few recent posts.. > > DHN> If NEHTA mandated a small development team to provide tools to translate > each independent > DHN> export XML schema into a standard format, then all the companies would > find themselves > DHN> in an embarassing situation if they objected to it, and also if they did > not provide tools > DHN> to import from it. > > > >>>>Probably more important is the need to establish potential use of the data >>>>Stipulate an open standard with certain components including medication >>>>list > > >>>We quickly start running into all the old walls. We have no reliable way to >>>identify individuals. >>>we can't agree on coding systems for diseases, and don't have any real >>>candidates for coding medications, NETHA are >>>still thinking about forming a committee to discuss a work plan for key >>>deliverables..... > > > DHN> In 1993, many people objected to using PIT format as an interim > DHN> measure. "Wait for agreed standards" they said. > DHN> Still waiting. > > DHN> Hugh > DHN> > DHN> XML export is good. XML import is better. This presumes there is some > DHN> sort of agreed schema. In fact, they are all different. None of EHR > DHN> developers publish them and if you use something approximating HCN's > DHN> they'll take you to court. > DHN> > DHN> I feel depressed. > DHN> > DHN> David > > > I think it is a big mistake to try and come up with a "New" format to > transfer data. You could come up with an XML schema that would be > simple and do what *you* want, and then someone else would want a > little bit more detail, some atomic data etc and try and extend it. > > After about 20 years of this and numerous committee meetings you would > end up reinventing HL7. I disagree, given "time again" you could make many improvements to HL7. Would it be "better enough" to justify moving away from the standard: that's a different question. The Australian extensions are poorly drafted and very ambiguous.
> Snomed CT is the national terminology for the UK and US and has been > nominated as the choice for Australia, you can dispute the choice (I > actually think its a good choice) but if we have made a choice we need > to get on with it and make it available. Big $$$, and quite path-specific (i.e. don't try coding a discharge from a psychiatric ward with SNOMED) Again the problem is, whose prepared to pay? Vendors will (in fairness must) pass the cost to GPs, who don't want to, hospitals are quite happy with ICD10 (with is basically free), so everyone points the finger at NETHA, and round we go again.... > The lack of a reliable patient identifier is a problem, but only a > huge problem when you try and aggregate large amounts of data, within > any one practice it can usually be handled reasonably. You are "not > allowed" to use the medicare number by law ????? > > Provider numbers are an excellent way to identify private providers > and are actually specified in the Australian HL7 standard. Based on > the track record of Government IT performance, waiting for a National > identifier is not wise. Now days most allied health providers also > have a provider number. Of course the lists of providers and provider > numbers are a "Top Secret" and not available unless you are a path > lab. Being required for getting medicare payment usually encourages > people to actually obtain this number. > > The walls are more imagined than real. We have national HL7 Standards > and even have a free testing facility - see http://www.ahml.com.au. We > have PKI/PGP/GNUPG etc Rich semantic communication is hampered by the > lack of standard terminologies but basic communication is not. So far > in 2005 Buderim GE Centre has delivered 13894 HL7 clinical reports to > local GPs and specialists, and on the Sunshine Coast alone, nearly > 100,000 clinical reports have delivered between Specialists and GPs. > > I is doable and is being done, I think waiting for NEHTA to act is not > going to be very fruitful. > > The idea of an Australia wide VPN is a bit strange, do you trust all > other health care providers in the country? Once it goes outside your > organisation the usefulness of a VPN drops of very sharply. Public Key > based Authentication seems the only workable option to me. > > All the talk of "Web Services" is a distraction. Any messaging > environment should have a "Service Orientated Architecture" by > default. What would be more useful is interface definitions and > national standards for EMail, HTTP Web Services, XML We You've hit the nail n the head. The problem is commerical forces are now arrayed *against* this. If messaging is standardised, there is little incentive to stick with a proprietary vendor once they (the vendor) have put in the hard yards in setting it up, thus destroying their business model. Ian H _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
