Tuesday, January 10, 2012

A Press Release That Conceals A Rather Large Problem. The Dominant GP System Provider Is Apparently Not Engaged With The PCEHR!

The following release appeared late last year.

iSOFT Demonstrates Progress at the NEHTA GP Desktop Vendor Panel

Monday, December 19, 2011 - iSOFT a CSC Company
Presenting at the NEHTA GP Desktop Vendor Panel on 6 December 2011, iSOFT demonstrated progress in preparing the practiX software to communicate health information according to the new NEHTA eHealth specifications.
Sydney, NSW – Earlier this month, iSOFT, a CSC company, presented at the National E-Health Transition Authority (NEHTA) GP Desktop Vendors Panel in Sydney. The purpose of the meeting was to review the progress of the six vendors participating in the project to prepare GP practice management software to communicate with hospital and specialist systems as part of the Federal Government’s PCEHR project. The first milestones in the project are to enable the applications to look up Individual Health Identifiers (IHI), accept discharge information and specialist letters – foundational elements of the Australian Government’s eHealth agenda.
Presenting along with iSOFT at the NEHTA panel were GP desktop vendors; Best Practice, Communicare, Genie, Medtech and Zedmed. Vendors demonstrated or explained the work they had been doing to enable their GP desktop systems to communicate health information according to the NEHTA specifications.
Each vendor showed evidence of progress against NEHTA’s milestones in preparation for implementation at the first GP sites early in 2012.
“As our eHealth solutions span primary, community, aged and tertiary care, we felt it was important to take an open and health system wide approach to meeting the NEHTA specifications. Using our iSOFT HIE Suite we are building interoperable components, that can work across iSOFT solutions and that are available to any application following the same NEHTA specifications,” explained James Rice, iSOFT APAC Managing Director.
“This open approach is of great advantage to state governments looking to implement Individual Healthcare Identifiers (IHI) across a health care system. Using iSOFT’s open Health Information Exchange (HIE) architecture, state departments of health will be able to identify and manage patients across multiple eHealth systems.”
Talking about the wider effort at iSOFT to achieve connectivity between applications, iSOFT’s Rice said, “Most recently we have used our HIE Suite to also enable our widely implemented Patient Management System (i.PM) for the HI without the need for customers to upgrade the core product. This is another example of the agility such a solution provides iSOFT and our customers.”
All vendors have now met the Wave I Release 1 requirements for use of healthcare identifiers. In addition to identifiers, iSOFT has achieved CCA conformance testing for the Secure Message Delivery (SMD) functionality. The SMD capability is part of the Release 2 functionality due 31 January, 2012.
iSOFT demonstrated the practiX GP desktop software interacting with the Medicare Individual Healthcare Identifier (IHI) database to retrieve a new 16-digit IHI number and associate it with a specific patient record. This functionality is the basis for the national eHealth reforms as it enables the secure sharing of health data across health care sectors.
The full release is here:
What is interesting in this release is this list.
Here are the vendors who were involved.
·         Best Practice (BP)
·         Communicare
·         Genie
·         Medtech
·         Zedmed
·         and iSoft themselves.
The reason this is important is what is missing - Medical Director is not there!
In terms of market share I believe BP is now up to a little over 20% of the market and that the others are a good deal lower - please correct me if I am wrong.
Figures from a year or so back - and they are pretty hard to come by for obvious commercial reasons suggest - roughly the following:
MD (Version 2 and 3) - 35-45%
Pracsoft - Around 20-30% (MD Financials etc)
Best Practice - Around 20%
Medtech - Around 5%
Genie - Around 7-15%
ZedMed - Around 5%
Practix - Around 10%
Let me know if any of these figures are off!
The bottom line is that MD is at least 40% and probably closer to 50% so to not have them involved is just commercial stupidity on the part of NEHTA and DoHA.
I wonder just what is going on behind the scenes here?


EA said...

CSC's submission to the current Inquiry includes
We would like to acknowledge that all the progress with respect to the creation of a Personally Controlled Electronic Health Record for every Australian who wants one is positive and it is especially heartening to see that all contributions have been in the forward, rather than backward direction.
Does anyone know what that last bit means?
Overlooking MD seems to a good example of heading in the wrong direction.

Anonymous said...

Well MD is not the only one “overlooked”. Medical Objects is not listed either. Perhaps they were not overlooked, rather they may have elected not to participate for one reason or another. Which means they were either smart or dumb but not both.

Anonymous said...

In summary:
1. purpose of meeting to review progress of six vendors in the project to prepare GP practice management software to communicate with hospital and specialist systems.

2. first milestones are to enable the applications to look up Individual Health Identifiers (IHI), accept discharge information and specialist letters

(a)Genie is a specialist system – are there any others involved?

(b)From which hospital systems are these vendors planning to accept discharge information from?
- iSoft’s hospital system?
- any others?

(c) Looking up Health Identifiers ‘should’ be fairly straightforward. What then?
- Does the HI get attached to the GP record?
- Does the hospital system attach the HI to the discharge information?
- Do the specialist letters carry the HI?

(d) Or is the sharing of the HI much further down the track?

Lagrimas de Luna said...

Medical Objects is a secure messaging provider, so it's no surprise that they were not included. Neither were Healthlink or ArgusConnect.
The dirty little secret that nobody wants to mention is that there is a reason why minor players are involved, while the big one sits on the sidelines: companies only participate in NEHTA initiatives if they believe their participation yields benefits such as greater market share. HCN are so dominant already that they have nothing to gain. It's as simple as that.
The industry does not really believe in NEHTA's vision, and as soon as the cash bribes flowing to vendors and GPs dries up, so will any and all cooperation.
What you have is a classic case of market distortion: incentives causing behaviour that would not occur without government intervention. Think of it as "pink bats for GPs". Cut off the cash and the gravy train stops.

Just another Wuss said...

The best dirty little secrets are the ones that are plain obvious. At least this one should be obvious, but people seem to have a hard time accepting it. As for market distortion, it's not really a hidden agenda or anything. But it's the role of government, to distort the market. Sometimes it has good outcomes by creating a new stready state that is better for the consumers, and some times it backfires. I don't believe that there is anyway to predict in advance what the result of any market distortion will be

Anonymous said...

MD is like the Microsoft of medical software. Archaic and slowly becoming irrelevant.

For all their shouting about standards, MD never sticks to them themselves (see HL7), and are bitter at the government for interfering with their plans to lock everyone into their Proprietary MD Exchange.

KH said...

Demonstrating, at this late stage, that one software provider (and maybe others??) can retrieve an IHI is a bit underwhelming, to put it mildly. Six months out from launch one would expect all providers to have IHIs AND provider identifiers - organization and individual - well and truly embedded in the software and routinely attached to referral letters, pathology requests, pathology reports, prescriptions etc etc. If these things can't be demonstrated NOW they are unlikely to be in production inside six months.

On the question of market share, I wonder if the figures quoted are for number of practices or number of doctors? The distinction could be important. We can agree that MD has been losing some market share, but I believe that the ones most likely to defect to another product are overwhelmingly the smaller practices. Large practices have a significant retraining problem if they change products. So it's entirely possible that MD could have, say 50% of practices, but 65% of GP's. For NEHTA to be disengaged from half or two-thirds of the clinical software market should be ringing the loudest possible alarm bells in the health ministry and everywhere else.

Anonymous said...

I agree with KH - underwhelming - 18 months after the launch of the HI service.

KH said...

Well, well, well.. HCN has been busy after all:


If this rather long URL is fractured, just Google "Medical Director delivers Health Identifiers". It's an article in the latest Pulse-IT magazine. I just checked the HCN website and there is a release in the "Downloads" section (MD/PS3.12.1a), but the download link doesn't appear to work yet.

So, 18 months after the announcement of a working HI service, we may be able to begin to get some benefit. It's progress!

Dr David More MB PhD FACHI said...

Hi KH,

See 9pm tonight post for more information.


Bob said...

As a health practitioner, government bureaucrat and IT dabbler I am appalled by what looks to be the inevitable conclusion here. A huge monetary black hole with a misguided government with little clue and a timeline that blurs into the distance. Even at this late stage many of my medical colleagues have little knowledge about the PCEHR. At this rate we will be lucky if the PCEHR will be running in a productive way inside of five years.