Craig Barnett wrote:
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??
I think:-
1. it is not a business protocol but an IT protocol where the request
and return are matched by the software.
2. that digest format disrupts threading.
David
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