I think this is a very reasonable presentation of the situation.
A few points of clarity are needed 1. GP's and specialists are medical practitioners not IT personnel accordingly it is reasonable to expect the medico to find the results in their clinical app. IT is not reasonable to expect it to be found on the the server somewhere??? Accordingly the clinical app to clinical app .ack is mandatory not a nicety. When I explain to clinicians the current the stat of play they are horrified when the realize how the current dump and run systems operate. A great deal of dangerous losses of information are covered up by the fact the vast majority of the at least the GP population still run blended records and so either concurrent paper information or the un recognized ...." the results are not in the file mrs blogs I'll just phone pathology ....." 2. The discussion highlights pathology - but in many centres people are thinking and talking specialist to GP messaging of letters and referrals etc and Visa Versa. Many of the people keen to commercially roll this out are not thinking clinician app to app .ack or understanding the enormity of NOT doing this. IN our surgeries modest electronic system there are 2200 external providers we utilize (about 400 are common!!) this greatly increases the volume and point to point complexity - hence any out going message I will be wanting a clinc app based reply from the other end - just as I expect for the Fax machine! 3. There is a use of the message carriers .ack files in it helps to narrow down where the message has made it to and helps with diagnostic trouble shooting ? There is also a use fot the carriers if they are parsing the message PRIOR to dispatching and assisting with the reconciliation process 4. The item missing is reconciliation !! This is predominately a BUSINESS PROTOCOL to check that messages and their receipts are being matched up. None of the local providers of electronic results (including unfortunately my own division of general practice clinical messages) are providing education or support or just a handout on how to reconcile. Eg Every time a doctor phones for an electronic result which is not in a patient file .... why are they phoning where did that message go?? Who checked todays error logs ?? etc I do not think the system is workable if extended to general messaging unless clinic app to app .ack files work and we develop a strategy to lift the level of in house GP and specialist reconciliation skills and process. Locally in the hunter I have had both major pathology and xray providers casually say to me ....." that's interesting you guys have not collected your messages for 7 days ...." clearly even within large organizations the monitoring of messages in a alert and professionally responsible manner is a low priority What do others think?? Criag -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Sunday, 11 March 2007 1:00 PM To: [email protected] Subject: Gpcg_talk Digest, Vol 18, Issue 27 Send Gpcg_talk mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk or, via email, send a message with subject or body 'help' to [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific than "Re: Contents of Gpcg_talk digest..." Today's Topics: 1. Re: Messaging Responsibilities ([EMAIL PROTECTED]) ---------------------------------------------------------------------- Message: 1 Date: Sun, 11 Mar 2007 10:16:01 +0900 From: "[EMAIL PROTECTED]" <[EMAIL PROTECTED]> Subject: Re: [GPCG_TALK] Messaging Responsibilities To: "General Practice Computing @ Group Talk" <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="iso-8859-1" On Sun Mar 11 4:37 , Elizabeth Dodd <[EMAIL PROTECTED]> sent: >On Sunday 11 March 2007 04:54, Peter MacIsaac wrote: >> In recent discussions about receiver responsibilities, both in Australia >> and at HL7, it has been suggested that the acknowledgement response to a >> HL7 result message should come from the GP application, not the >> communication client. >> >> This ensures that the sending pathologist for example at least knows that >> the report has made it into the referrers application. I understand that >> there have been examples of reports falling into the void at that level ie. >> Pathology system feels that delivery has been acknowledged and GP system >> does not really have it. > > >But getting into the application still does not guarantee that it has got into >the practitioner's brain. No system guarantees that. One of my associates >happily stamps every path report on paper as read, never checks the on-line >version unless the patient is present, and feels that he pays his medical >defence premiums to deal with the aftermath. This is hardly the pathologist's problem, and so not the issue. The issue is what level of acknowledgement does the pathologist need to be able to 'sign off' legal responsiblity for delivery. Certainly messages do go missing in the EHR <->messaging client step, as this occurs entirely within the GP's system, one could argue that this is also not the pathologist's problem. However, as most messaging clients are provided by the pathologists', it becomes a bit grey. Certainly the authors of the HL7 standard wrote assuming it would be the app receiving the data that generates the ACK message: it is supposed to signify that the message was parsed correctly and incorporated into the EHR. Once again, we are at the mercy of vendors who will implement standards or not as they damn well please. Leaving that aside (or rather, in fairness to the vendors) this is not possible until there is a standard for communication between the clinical app and the messaging app, which, one assmues, it what the proposed meeting is about. This begs two questions: 1/ if you set a clinical app <-> messaging app standard, why not set a clinical app <-> clinical app messaging standard and do without messaging apps altogether? 2/ given 1/, and that transmission is guaranteed by the ACK, what does a commerical 'messaging provider' do? Ian ------------------------------ _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk End of Gpcg_talk Digest, Vol 18, Issue 27 ***************************************** _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
