Hello All, the same messaging questions keep coming up again and again.
The problem is to a large extent political and to some extent because of historical precedents and ingrained expectations. Running reliable scaleable messaging between all healthcare providers in Australia is not a cheap exercise. The constant shifting around of providers and the low availability of dedicated full time IT support in practices mean that reliability of delivery depends on constant monitoring of delivery and "chasing up" practices who have lost a server/changed their hardware or even not logged in the workstation. This is not a failure of software usually, but a failure to manage the infrastructure with the attention it deserves. This is probably the biggest argument against EMail, there is no good way to ensure delivery in an environment where the receiver is not managing their own infrastructure. As pathology companies have historically provided their own messaging for free there is an expectation by providers that it continue to be free to them and that support is provided by the sender. This is different to a fax machine, where the receiver has a responsibility to buy and maintain the hardware and ensure its working. The sender pays the cost of a call, but no more. So if we continue to use the current model, which is hard to break out of, then the sender is not just paying the communications cost (which is small) but also the cost of installation and support for the receivers. This is probably the largest component in reality. It certainly costs pathologists a lot to maintain their own clients. Given the cost of maintaining the receiver, it is not easy to allow anyone to send for no cost, as they are responsible for a proportion to these costs. This makes an open system difficult. Argus is "Free" to specialists and GPs but the onsite support costs are not, and that is not free in reality as installation and maintenance is required. They also have to charge large organisations a lot to cover costs, although the infrastructure provided by them is in reality small (as they depend on the 386 that runs Telstras email infrastructure). A model where the receiver pays for software, support and a proportion of infrastructure costs would be a lot fairer as then the client could be open and anyone could send for free if they provided their own software to do so. In this model someone has to pay for managing the directories etc and this could be spread over all users. I would be more than happy to move Medical-Objects over to this model, but I think the chances of GPs agreeing to pay for a service that has previously been free is small. So in the end the major barrier is that by the receiver not paying the sender has to, so the systems are not open. Argus is not open, the directory is protected, we could easily and automatically send to Argus users if it was, but this would damage their ability to sell the sending software. The solutions are a 1. monopoly provider, like NZ, or 2. Publicly funded infrastructure - which seems unlikely to get off the ground in current climate, or 3. GPs continuing to install multiple clients until option one or two happens. The option of changing the model to receiver pays seems very unlikely to be viable. ie Option 4. It would involve you (ie all GP's) paying some amount of money a year to have one client installed - that any of the other providers could send to for free. Maintaining that client would be your own responsibility. Setting up an open interface for this would not take long. The issue of standards comes down to compliance. When medical software is certified to reliably import and export Australian standards compliant messages the problem will go away and we can start worrying about the semantic interoperabiliy issues. Medical-Objects remains, from Mid 2005 to this date, the only company certified to produce Australian standards compliant HL7. Many packages actually don't handle compliant messages well so we can modify it away from compliance if need be, but we should not have to. Pathology companies hesitate to spend money to produce compliant messages when they may not be imported reliably, hence PIT lives on. Some insistence by users on this front would be a big help, Ask your software vendor do they reliably support compliant AS4700.2 HL7 messages? -- Best regards, Andrew mailto:[EMAIL PROTECTED] Andrew McIntyre Buderim Gastroenterology Centre/Medical-Objects 102 Wises Road MAROOCHYDORE Q 4558 www.medical-objects.com.au _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
