Messiahs or Misers... Your cryptic exercise for the day Peter MacIsaac
Regards John Johnston BSc DipSci AIMM Managing Director 0408 276 742 -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Peter MacIsaac Sent: Monday, 19 March 2007 10:02 AM To: 'General Practice Computing Group Talk' Subject: RE: [GPCG_TALK] Messaging Responsibilities Andrew, As you have said we will be discussing this issue at the workshop on Thursday and if there is industry support develop a pragmatic and standards based way of addressing this issue. So if an application level ACK became required as a result of its inclusion in an Australian diagnostic messaging profile, the vendors could decide whether they wish to incorporate the feature and be certified (probably by AHML) as profile conformant or not (and take the commercial and medico-legal risks of going down that path). This is the model developed by IHE for supporting standards integration. The key issue is whether market incentives will emerge where GPs, Specialists and Lab/Radiology providers will choose to specify and buy a "profile conformant" product. Of course there are other forces at play relating to practice accreditation and incentive payments which could also push in that direction if it is deemed in the public interest to do so. We should be able to create a situation where an electronic c.c. or copy report should be able to be delivered to any provider. This is going to require agreement about a range of standards and how they will be implemented to create an open and interoperable communication solution. I don't wish to see participation in the Interoperabilty Demo becoming an industry football or punching bag. Different companies participated at varying levels in our first two demos. I think those who participated in the demos and observed them will have noticed the pivotal role that a number of key vendors played. This year we are hoping to standardise the demonstration and make participation contingent upon meeting the requirements of the pathology/radiology messaging profile. Looking forward to a constructive meeting this week. Peter MacIsaac Diagnostic Workshop and Interoperability 2007 coordinator For HISA, HL7 and MISA. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Andrew McIntyre Sent: Saturday, 17 March 2007 3:13 PM To: General Practice Computing Group Talk Subject: Re: [GPCG_TALK] Messaging Responsibilities Tom Bowden wrote: > > > Dear Colleagues, > > At HealthLink we have been watching the discussion on messaging > responsibilities with great interest. It was timely that David More > provided an excellent link to a video on use of messaging etc in the > Dutch health system. The key point we think should be noted is that > you cannot get to this level of automation without all involved having > complete trust in the system, especially trust in the fact that it is > safe and 100% reliable > > As readers are probably aware, HealthLink is a messaging and security > system provider active in Australia, New Zealand and Canada and > therefore we have a number of environments upon which to draw upon for > examples and comparisons. > Thanks Tom, I printed out your document and left it on my Desk overnight, but there is now Tojan Horse Poo all over my desk..... I am all for application acks, and correct ones at that, but this would achieved if PMS applications were AHML accredited and a standard interface to the PMS was adopted. Your proposal turns standards based interoperability into interoperability based on contracts. Surely this would lead to kickbacks where the messaging provider pays the PMS provider for the (?exclusive) ability to interface with it. Please assure everyone that this is not part of your plan! "Plug and Pay" is perhaps the best term. This may well be Healthlink's Business model and the PMS vendors might appreciate another income stream but It would be at the expense of the users, as someone has to pay for that access. We have already seen pathology companies forced to pay PMS providers for the privilege of getting non standards based electronic orders and this proposal adds a new toll both in the other direction. You need to reread the HL7 standard as your interpretation of it is incorrect. "Pathology Messages" as you describe them, are in fact for any clinical data, this is directly lifted from Chapter seven (ORU Messages) "These transaction sets permit the transmission of any kind of clinical observations including (but not limited to) clinical laboratory results, the results of imaging studies (excluding the image), EKG pulmonary function studies, measures of patient status and condition, vital signs, intake and output, severity and/or frequency of symptoms, drug allergies, problem lists, diagnostic lists, physician and nursing history, physicals, progress notes, operative notes and so on. These transaction sets carry information that is reported as text, numeric or categorical values" On the question of the correct use of ACKS: This is from chapter 2 "The HL7 Standard makes no functional interpretation of the requirement that a system commit the data in a message to its database before acknowledging it. All that is required is that the receiving system accept responsibility for the data, providing the same integrity test that it would apply to data from any source. To continue the prior example, the ancillary system may acknowledge the order after placing it in an input queue, expecting to fully process the order into its database at a future time. The only assumption is that the input queue is maintained at the same level of integrity as the database." Now I support application ACKs, but deleting the input queue before committing it to the database is quite poor practice, Only a small number of applications generate ACKs and many do not yet support HL7 at all. Healthlink also uses Non-Standard "RSD" messages for clinical data. Thats not a message type I can find in the HL7 Manual? We have tested the available REF messages in The Hunter trial and found that while 2 PMS's could import them, they were not brought to the attention of the target doctor, and were not felt safe to use because of this. wrt The discussions at the HL7 Meeting next week I would suggest: 1. A common interface for PMS data import be created which allows for application ACKs to be reliably checked. This could be eg: 1. Directory Based or 2. A SOAP interface into the PMS 2. A commitment made by PMS vendors to achieve AHML accreditation for created messages within 12 months. 3. A test set of Compliant messages be developed that test (and stress) the import capabilities of PMS systems. Ideally this testing should be done by a third party eg: AHML 4. A common SOAP interface be developed for encrypted HL7 data transfer so that PMS vendors can implement their own interfaces and message transport in the future. 5. A common SOAP/HL7 interface be developed for Provider lookup and PKI key management to allow for 4. to be implemented 6. A commitment by messaging providers to implement 4. and 5. within 12 months and publish a per/kb fee for message delivery to allow for open competition based on standards. This would open the market and make interoperability a technical issue rather than a contractual one. Compliance with existing standards would do more to improve patient safety than a bonus load of contracts ever would. The long term aim is to be able to turn up at a connectathon and inter-operate with multiple vendors without having to speak to their CEO to negotiate terms first. This level of interoperability is not easily possible at the moment because of compliance issues rather than a lack of signed contracts. Medical-Objects has participated at both HIC Connectathons in Australia and made it happen, Argus has participated in the first, I note Healthlink did not deliver any messages in either event, despite showing just enough interest to get your logo in place for both. Andrew McIntyre Medical-Objects. _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.5.441 / Virus Database: 268.18.13/725 - Release Date: 17/03/2007 12:33 PM -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.5.441 / Virus Database: 268.18.13/725 - Release Date: 17/03/2007 12:33 PM _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk John Johnston Pen Computer Systems Pty Ltd Level 6, The Barrington 10-14 Smith Street Parramatta NSW 2150 Ph: (02) 9635 8955 Fax: (02) 9635 8966 _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
