Tom Bowden wrote: > Dear Colleagues, > > All people reading this list should be aware that unless a messaging > system is fully integrated with the EMR (electronic medical record) > software at either end of the communications link, it is > hazardous. Would-be purchasers should not be taken in by the > superficial allure of a piece of software that provides part of the > communications loop and purports to handle the rest but in fact leaves > the rest of the process almost entirely to chance.
Yes, realtime point to point delivery with a distributed architecture - I don't think that arises by chance... HL7 is the integration point. > > A few of the questions that need to be asked... > > > 1. Typically such systems do not provide a full end to end > acknowledgement loop as they rely upon the intermediate (messaging > system) software to acknowledge the incoming messages - This means that > such systems are _absolutely not HL7 compliant_. I know that you feel that if you keep saying it people will think that is true, but it is not. There are in fact several levels of ACKs in HL7 and while will will support HL7 acks from PMS systems this ability is not universal as yet. Healthlink is absolutely not AHML accredited but you continue to allude to the fact that you are. > > /Does this system send its own acknowledgement messages (to itself) or > does it rely upon the recipient application's ability to acknowledge > (which is the right way to do it)? / > > 2. Typically they turn everything into an observation message (ORU) > instead of a referral (REF) message . While technically this is not > "illegal" it certainly bends the rules and creates a very difficult file > management headache for the recipient. The level of support for REF messages is still not mature, and in reality a REF message is a container for multiple ORU messages and Medication details. So the difference is somewhat academic in most ways, especially when the current crop of REF messages often contains a single Blob of poorly escaped RTF. Its the non compliance of the payloads you carry that causes you headaches. Medical-Objects is an active member of the voluntary Standards Australia working group that is specifying the REF message and is also involved in the committees for several other message types and I would appreciate you coming and helping given your strong beliefs. > > /How does this system deliver non observation messages, as ORU or REF > messages? / > > 3. Typically such systems vendors have no support or other > relationship with the EMR vendors and in a number of cases, this one I > fear included . They are therefore viewed as competitors by other EMR > vendors - the net effect is an antagonistic relationship when it comes > to any problem solving and little or no helpdesk collaboration, joint > documentation etc . Medical-Objects takes responsibility for sorting out the issues before we send the messages to try and reduce the issues at the destination. The level of co-operation from vendors varies, and probably mirrors the quality of their end user support. I think that the relationship should be a professional one rather than a business one, but I know you see the world as a place of deals and financial arrangements. We are just old fashioned I know. > > /Does the provider of this system have a contractual relationship with > the EMR software providers at either end of the delivery chain or not? / > as above.... We see our users as our customers and they have a contractual and financial relationship with their software vendors. I think for us to have a hidden financial relationship with their vendors is unnecessary, but I don't think you agree. The message is transmitted from doctor to doctor and the HL7 and PMS is just the vehicle. > In summary : > > Users should be aware of the limitations and dangers of using > _non-integrated communications systems_. If they persist in using them, > they should ensure that they continue to send paper copies of > _everything_ in parallel, they should advise all of their partner > organisations to ensure their medical indemnity insurance is fully > paid up and advise their patients that they are part of an experimental > programme that aims to show that common sense approaches to healthcare > messaging are no longer needed. I think a positive approach outlining places where you have achieved doctor-doctor messaging would be preferable to scare mongering, As a doctor I live with risk all the time and Medical-Objects has taken the step of becoming AHML accredited and having a deep understanding of the standards as defense against these risks. We are continually moving ahead to enable real time messaging so there will always be some experimental sites, but then again there will be no progress unless this is done. Widespread real time point to point messaging is what we are delivering today and that has only happened with R&D. I appreciate that the healthlink central hub model is old technology that has been experimented on in NZ and is now fit for the Australian masses. > > Electronic messaging has to be a very disciplined business. In a fully > connected Australian health sector approximately 1 billion messages will > be exchanged annually. This cannot be done on a wing and a prayer. If > the sector wants to see a fully interconnected messaging environment, > then this must be done according to rigidly enforced standards, > especially important is adherence to those standards that relate to > delivery integrity. > > It is time to look at this issue in a bit more depth. Yes and I think realtime distributed systems are what we should be aiming for. An open standards based environment is highly desirable to avoid Monopolies developing don't you think? Ideally then the EHR applications could then do their own messaging and avoid the middleman altogether, that would be even safer. Andrew McIntyre Medical-Objects > > Kind regards, > > Tom Bowden > > > > *Tom Bowden <mailto:[EMAIL PROTECTED]>* > /Chief Executive/ > Tel: +64 9 638 0670 > Mobile: +64 21 874 154 > Email: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]> > Web: www.healthlink.net <http://www.healthlink.net/> > > <http://www.healthlink.net/>* > Connecting The Health Sector* > _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
