Monday, September 06, 2010

This is Really A Sad State of Affairs. We Need to Look Closely At What is Going On!

The following appeared last week.

Australia behind on e-health: HealthLink

  • Karen Dearne
  • From: Australian IT
  • September 01, 2010 10:05AM

NEW Zealand continues to outpace on e-health Australia still grapples with key design, funding and planning issues.

Tom Bowden, chief executive of Auckland-based secure messaging and integration specialist HealthLink, said Australia had failed to do the hard work on building basic capacity, setting standards and improving data quality.

"All the really flash stuff has been worked on and there's been lots of bright ideas, but the real effort is still to be done and we won't see solid progress until that occurs," he said.

"Nowhere near enough effort has gone into getting the quality of GPs' electronic patient records up to scratch, and organising standardisation of the information that's to be exchanged."

In contrast, 100 per cent of GPs were using fully functional e-medical records by 2000; 100 per cent have been doing clinical messaging and 95 per cent of hospitals have provided e-discharge summaries over the same period. Because of this infrastructure, New Zealand has been able to build and release a raft of more sophisticated applications.

The latest is electronic referrals from a GP's office to hospital specialists. HealthLink has completed the rollout of a web services e-referral platform across half the country. New Zealand celebrates the 10th anniversary of its universal patient record system this year.

"A hospital offers a menu of referral types depending on specialty, the GP picks one and the GP's system automatically picks up all the required information with one click," Mr Bowden said.

"The referral is then submitted electronically to the hospital, where it becomes part of the patient's incoming record.

"Where the system is in use, some 80 per cent of referrals are being done while the patient is in the GP's room, during a 10-minute consultation.

"The specialists like it because they get all the information they need, and the inclusion of test results or digital photos cuts waiting time because they have a much clearer understanding of what's wrong."

Mr Bowden said New Zealand achieved its connectivity using the messaging standard HL7 version 2, while most labs in Australia still used the outdated pathology reporting format PIT.

"I'm sad to say PIT should have been replaced long ago by HL7v2, but its use for pathology messaging is still rising," he said. "This gets back to basic messaging not being properly run here.

"Every lab is supposed to go through testing with the Australian Health Messaging Laboratory to ensure their conformance with HL7v2.

More here:

If ever there was an example of ‘perfection being the enemy of the good’ in e-Health it is the comparison that can be made in progress in the basics between NZ and OZ. Even with a financially more constrained nation it has been possible, with some decent strategic leadership to more steadily, if not rapidly forward. Pity we have not been able to replicate the same here!

I leave it as an exercise for the reader to suggest how we might change things to improve our chances in the future.

This blog offers some of my thoughts.



Anonymous said...

Yep - those kiwis seem to have their act together. For a few decades now ( I think) they have had a national patient identifier system, which also includes a medical warning component with allergy and alert information. So every time a patient record is opened say in a hospital PAS system, the patient record is refreshed from interfacing with the national hub. At last we can look forward to that in Oz as well - with the work that nehta and medicare are doing...but here's a thought - perhaps we should have just hooked into the NZ system instead? Then we could get allergies, and referrals too! Beached as!

Anonymous said...

Yeah right!
The grass is always greener...

NHI is riddled with duplicates and bum info, in spite a a recent clean up.

HPI (providers) stated 10 years ago and still incomplete. most systems can't even tell is a Dr is registered, let alone nurses etc.

Our COPY of the AMT still not released.

Anonymous said...

A note from NZ. We look at the Oz environment with interest. Significant investment, many trials, but little return.

Also have a look at All lab results (community and hospital), all hospital Rad, plus community drug dispensing stored in a regional database for all clinicians to see. NZ have a Testsafe Clinical Data Repository (CDR) for the Auckland region and South Island.

The current health IT plan is to have 2 others CDR (midlands and Central) to cover the whole of the country.

This is a pragmatic approach with clearly defined returns.

But we would still love to have funding equivalent to the West Island.

Bruce Farnell said...

The messaging issue is a very sad state of affairs. Ideally, all message senders should be checking their messages against the AHML. Unfortunately, if receiving applications fail to handle these messages in the same way the sender is forced to cobble together different message formats for different clients regardless of what the standard dictates. Failing that - they will send PIT formatted files. That has been my experience.

I have no doubt that the medical software industry is keen to resolve this along with other issues. Unfortunately, this issue needs leadership at the highest level to achieve the necessary level of cooperation. Perhaps the successor to NEHTA might achieve it. Meanwhile, PIT files will continue to sent in situations where atomised HL7 messages would be more appropriate.

Tom Bowden said...

I am a little bit concerned that I have been too strident in my criticism in the Australian article, however I do think it has been a useful addition to the debate, even if rightly viewed as a tiny bit parochial.

I am interested in Bruce Farnell's view and while I do sympathise with his plight (seemingly condemned to use PIT messages for eternity) I do suggest a much harder line be taken on messager senders. Let's face it, there is simply no compulsion for them to send messages of any consistent level of quality. The developers of the recipient systems are very keen to get highly standardised messages. Lets just agree on siome simple compliance rules and then see they are followed.

Or is it not that simple?

Anonymous said...

I think you are a bit harsh on PIT. It was quickly developed to fullfill a need to deliver pathology results, and it was rapidly adopted because it worked. And patholgy results delivery is still far and away the most successful e-health activity.

The delivery cost is borne by the sender, the recipient pays nothing, and in the early days the recipient software was basically free too.

So from the sender's perspective there is limited incentive to add extra cost and complexity by adopting HL7 as the delivery method.

And until the advent of PIP Diabetes Incentives for Diabetes/etc Patient Registers there was little incentive for recipients to use HL7 to gather atomic results to maintain the registers.

For the adoption of HL7 messaging to increase markedly there will have to be a change in the business requirements, such as other service requirements i.e. e-referrals, or changes in the way the service is funded to make it worthwhile for senders and recipients to incur the extra cost and complexity