Hi everyone,
Thanks for all your responses to my posting, I am now coming to terms with my new understanding of NEHTA's role. I have one or two comments about Ian Haywood's posting. Ian wrote: "Ultimately it's the GPs who need to get off their/our backsides and start making choices. - 5-6 messaging products each separately supported for free - 1 standard-based downloader that you must support, or pay for support. Hi Ian, While I think you make an important point about the need sort out messaging, I think the issue of which "downloader (or downloaders)" it is just a subset of the "communications management issue". Now that we have some international body of evidence as to what works and what doesn't (in terms of automating health sectors), I don't think the whole thing is actually that complicated. On NEHTA I have been a strong supporter of NEHTA, thinking that they would get in and lead the whole e-health agenda, however they appear to have shied away from leading change, taking an academic approach producing their beloved web-services standards which may replace the different web-services standards used which is all well and good. But for those of us hoping for major change in the communications space emanating from NEHTA, it is now back to the drawing board. NB critical comments relate only to NEHTA's messaging activity, I am still really hoping they can do good work with master patient indexes; hoping and praying! On messaging I firmly believe that point to point messaging "downloads etc" shouldn't be viewed in isolation, they are part of a much bigger picture; For instance we (HealthLink) are currently doing a project in which 20 separate electronic referral forms dynamically published by a hospital are populated within the GP apps and submitted in real-time as HL7 2.4 referrals. These are really high value capabilities that could not really be described solely as messaging. They involve messaging but there is a lot more to them than just messaging. Without a doubt giving the sector a single "standards based downloader" would stymie innovation in the space. My point is that to achieve a really useful, dynamic level of communications, you need a party (ies) that will design and sell, put this kind of system in place, trial it, support it and then enhance it and reuse it. To make this viable there needs to be some money changing hands to pay the staff and from a "risk" point of view, such an activity is best suited to a private sector organisation than a government agency. BTW everything in the above project is based upon standards either published or draft and all IP related to standards developed en route belongs to the sector, HISO the NZ standards body is working alongside us. The service provided includes support of PKI, on-site support if needed for GP and hospital, vendor liaison (both GP and hospital system etc, etc) and we take full accountability for the success or otherwise of the project. . The health region is charged on a fixed fee per month calculated on the number of patients in that region and it is a mighty small fee if you take into account the value that the health region will get from automating all incoming referrals in this manner. - So it is actually a slightly broader issue than standardising on a single downloader or not... On what to do.... I am firmly of the view that a number of specialised private sector entities should be encouraged to compete in that space and to provide services based upon rigidly enforced but well thought out standards (supported developed by a dynamic 'bottom-up' standards process). We already have enough HL7 standards and a PKI to get us started. I note that Professor Denis Protti said in his 10 country review of primary care computing that "A unifying organisation such as Medcom in Denmark or XXX in New Zealand is common to all well-integrated countries, with some type of Government impetus also present." My view is that in Australia, rather than have a single unifying organisation as in smaller countries, there should be several competing ones and all should use the same set of rigidly enforced standards and agree to abide by a code of ethics, governed by one or more key sector bodies GPCG? AMA? . That would allow openness but also enable the private sector involvement and innovation which I believe is key to success in this area. I know you will say it is a self-serving view, but it is my sincerely held view nonetheless, that we should support a group of players to emerge and compete in the role of Unifying organisations and work closely with government to get the job done. Bottom line I think it is urgent that those HL7 2 standards that have been worked on long and hard are made compulsory and all government incentives to GPs tied to their use. It is a real pity after so many years of work that Australia is still in the dark ages with PIT messaging and a range of variants of HL7 messaging plus GP systems that don't even use the atomic data if it is supplied. We should demand use of standards compliant messaging and use AHML to certify compliance and send any systems that don't comply packing, that would be the first and most important step in getting interoperability sorted and would be a damned fine thing to do. How about rallying together to make that happen? Anyone with me on that? Kind regards Tom Bowden
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