Tim Churches wrote:
The Internet works as well as it does because all the smarts are at the
edges, in the applications, not in the actual Internet networking
infrastructure itself, which is very simple (and hence reliable and
scalable, given the immense scale of the thing). So it should be with
clinical messaging - let the oversight function for messaging, which
ensures its reliability and safety, be built into the clinical
applications, and have the simplest possible transport mechanism in between.
Tim,
A couple of things come to mind from what you've said. Firstly, that we
shouldn't be seeing secure messaging as something separate from an
electronic health record at all, and the future for all the messaging
guys may be to provide the functionality for the clinical guys. Now
which one of the messaging methods is the question.
It would also seem to mitigate against storing stuff outside the
applications, in line with your Internet analogy. Except for E-mail, of
course. Funny that.
Further, as others have said some time ago, none of this assures anyone
that the clinician has seen the relevant report. I previously menioned
that MD, at present, allows clinicians to check if there are any results
outstanding for tests ordered. The clinician then must check the list,
which seems to me entirely reasonable.
Automated pop-ups could be added that trigger after a time if no
matching result has been received for various categories of tests.
Nonetheless, the clinician then has to initiate follow-up on the missing
result. I don't see how that can be avoided. I'm just wondering how much
more can be done at the application level?
The other thing this situation reminds me of is when you had to get a
copy of Trumpet Winsock if you wanted to have a dial-up Internet
connection work with Windows 3.1. Except that that we have many more
clinical software vendors with far smaller client bases, and there is no
standard functionality that can be added to all flavours of the
software, so moving onto an integrated model, will be much, much harder,
I would think.
In the meantime, maybe messaging level acks and nacks will be around for
some time yet?
Greg
--
Greg Twyford
Information Management & Technology Program Officer
Canterbury Division of General Practice
E-mail: [EMAIL PROTECTED]
Ph.: 02 9787 9033
Fax: 02 9787 9200
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