I am surprised to find myself agreeing with you Ian, but I certainly do. To me it is very clear that unless you have an organisation/set of organisations that are focused on solving a particular complex problem (in this case sector communications) it will not get done properly. Unfortunately it costs a modest amount of money to run any kind of organisation, especially one charged with the all important task of ensuring end-to-end communications across a health sector.
There are clearly a number of alternative business models. The one I prefer, as used in Scandinavia and in New Zealand is where a small number of organisations take end to end responsibility for messaging and security as "health sector integrators". These integrators ensure that all of the parties that use their integration services are standards compliant and they focus upon developing interfaces and systems that are robust and efficient in order to reduce the cost of running the service. Ideally these Health sector integrators (HSIs ?) are run on a competitive basis and there is compulsory adherence to a range of technical and performance standards and a fair degree of external governance imposed. All integrators need to interconnect with each other, using agreed standards. This is in effect how I believe things should evolve in Australia and it is certainly towards this end that we are working in the group ably led by Peter McIsaac and Vince McAuley. In terms of who pays for such a service? This can be done in any number of ways, I think it would be best if some of it were paid for by practices out of an overall annual payment for purchase of IT services that they get from their funder. Some of the cost can be paid by hospitals and laboratories as well; wherever the value is created. I think that if you have a detailed look at the latest Commonwealth fund survey "Mirror Mirror on the Wall" you will see the significant improvement in sector efficiency delivered via this kind of business model. Interestingly too, the US has in the last 10 days issued an interim report on the proposed Architecture for the National Health Information Network. The Gartner authored report recommends a network of networks operated by competing service providers, in almost exactly the same manner as I am suggesting. NB The link to this document is on the latest posting on David More's excellent blog site. I believe that we now have some clarity as to how e-health will ultimately emerge from where it is now; via a set of interconnected, competing health sector integrators. Interested to hear the views of others. Kind regards, Tom Bowden CEO HealthLink 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 -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ian Haywood Sent: Monday, 11 June 2007 11:59 p.m. To: General Practice Computing Group Talk Subject: Re: [GPCG_TALK] Connecting users of different clinical mesagingsystems On Monday 11 June 2007 21:03:11 Oliver Frank wrote: > An open membership working group has been formed to tackle these > problems under the auspice of the Medical Software Industry > Association (MSIA), Health Informatics Society of Australia (HISA) and > HL7 Australia. The current industry membership is: > * Argus Connect > * eClinic > * HealthLink > * Medical Objects > Members of this group will work on a technical solution to enable end > users, such as GPs, Specialists, Pathology and Radiology Services, and > hospitals to contract with one provider, should they choose, and that > communication can be directed to any recipient." This sounds like a great idea and its long overdue. The key issue is the business model. Imagine a "Pathologists' and Radiologists' Communication Company". This is a vendor which refuses to have GP clients and install on their desktops, Instead it has radiologists and pathologists only, and sends to GPs via the other vendors. Advantage? This company does not need to subsidise free installation (which GPs demand) and so can undercut the others for the senders market. HealthLink, MO, et al. then exist solely to provide free support and software to GPs: not sustainable. This is why, in a perverse way, I agree with Tom Bowden: inter-operability must be on a contractual, rather than a standards basis, however I would add this is a consequence of the business model, not of the fundamental technology. Ian Haywood _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
