Sunday, August 05, 2012

I Had Not Noticed This Service Had Kicked Off. Interesting How It Is Being Done With Another ‘Slow Launch’ I Suspect.

I noticed this a few days ago.

The National Health Services Directory (NHSD)

About Us

The National Health Services Directory (NHSD) is a convenient and accessible new resource.  It builds on and consolidates some existing regional healthcare directories to provide detailed information on available health related services to anyone with internet access.
The directory provides access to reliable information, and will assist you to choose and connect with the most appropriate health services for your current needs.
The NHSD covers the nation. It will be freely available and will include both public and private health sector providers from all Australian states and territories.
Implemented by the National Health Call Centre Network (NHCCN) on behalf of, and with the support of, all Australian Governments, the NHSD will initially provide service information for GPs, Pharmacies, Hospitals and Emergency Departments.
Developed to support health providers’ delivery of services in addition to facilitating public access to reliable information, the NHSD will be enhanced to include secure access to practitioner information as well as mental health, allied health and local hospital services data information.
To assist your planning and health service selection the NHSD will be further extended to include allied health providers and human services in the coming months.
The NHSD is being developed using national and emerging international standards based largely on the successful implementation of the Victorian Human Services Directory (VHSD) and other directories of significance around Australia.
Coverage will include but not be limited to healthcare and related human service providers. Information provided will include: service types and location; opening hours; languages spoken; access to bulk billing and supported types of communication.
The full website is found here:
This page I found very interesting.

Health Departments

The NHSD is a strategic component of the National Health Reform Agenda.  It is a joint initiative of all Australian governments which will not only support existing services but help enable many eHealth activities.
The National Health Services Directory will make use of existing data sets and directory information held by the various state and territory health departments.
This information will be updated, checked for consistency and extended to provide a national data set which can be used by all government health departments and other groups within the health sector.

Benefits of a shared and consistent national directory

  • Make available accurate and current provider and service information to support health professionals in their delivery of care planning and referrals
  • Help Australians search for and locate healthcare services and providers where and when they need them.

What the future holds

The NHSD creates a platform for ongoing inclusion and enrichment of data and functionality. The directory is expected to provide an Endpoint Locator Service (ELS) to assist in secure clinical messaging and to incorporate information for telehealth over coming years.
The page is found here:
From the FAQ we have the following:

Why was the National Health Services Directory (NHSD) created?

The NHSD has been developed to support health providers’ delivery of services in addition to facilitating public access to reliable information. It will be enhanced to include secure access to practitioner information as well as mental health, allied health and local hospital services data information. It is expected to provide an Endpoint Locator Service (ELS) to assist in secure clinical messaging and to incorporate information for telehealth over coming years. 
The time line for development is interesting:

When will Health Service Information be available via the NHSD?

Now
Service information for GPs, Pharmacies, Hospitals and Emergency Departments.
Late 2012
Increased secure and detailed information on services and practitioners for primary care, mental health and local hospital network services.
2013
Extensions to allied health and human services.
-----
The partners with the National Healthcare Call Centres Network (NHCCN) are the Jurisdiction and NEHTA.
As the site points out:
The NHSD (National Health Service Directory) is operated by the NHCCN on behalf of all Australian governments. It is a operated as a not-for-profit community resource. © All Rights Reserved.
Key to my interest in this is the proposal for the NHSD to - over time - develop an End Point Locator Service (ELS).
Why I am interested is that the ELS is one of the missing parts of workable NEHTA secure messaging which is, of course, a rather key part of the NEHRS program. Without safe and secure message transmission between providers and the NEHRS (both ways) the NEHRS is about as useful as a ‘barnacle on a battleship’.
Secure Message Delivery (SMD) requires (as well as the various network connectivity between sender and receiver) three things.
1. Standards regarding message content and handling (HL7 etc.) etc.
2. Encryption and message decoding standards (typically PKI as planned to NASH)
3. A directory that can permit the sender (and their message) to electronically find the intended recipient. This is where the ELS comes in.
We have a Standards Australia IT-14 Technical Report covering this area.

TR 5823-2010  - Endpoint location service.

Published:   05 Mar 2010
(Interestingly NEHTA and Microsoft seem to have contributed different views on this area and what underlying approach should be used.).
As I type there is no national ELS and reading the above it seems we are going to be waiting a while for what is said above is “It is expected to provide an Endpoint Locator Service (ELS) to assist in secure clinical messaging and to incorporate information for telehealth over coming years”.
In the meantime our various messaging providers each have their own directories for their users.
Also, of course, it seems NASH remains in a hole with all sorts of rumours around just what work is going on and just who, if anyone, is doing anything.
Essentially of the three parts you need we maybe have one at best - with the other two being just ‘twinkles in DoHA’s/NEHTA’s eyes’.
Just where this leaves a securely accessible NEHRS is anyone’s guess. So much for getting the ducks aligned before starting a project like the NEHRS.
Updates / answers as to what it all means on a postcard please (a comment will do!).
David.

13 comments:

Anonymous said...

You have raised a very sensitive topic. I understand from a senior clinical lead representing NEHTA that HSD is a thorn in the side for NEHTA. When I asked why I was told that NEHTA can not use HSD at present which is problematic and that for NEHTA legally to be able to use HSD some significant legislation needs to be changed. Changing legislation so I am told is an even bigger problem. Perhaps others can contribute more insight to the issue.

Anonymous said...

I don't think an ELS is necessary for PCEHR - you just make the big central computer system a 'known' destination for the clients. An ELS is really only necessary for ad-hoc many-to-many communications.

I don't even think SMD is required for communicating with the central servers for PCEHR - they are just using web service calls, and you can SMD the data as an alternative comms method (??).

Dr David More MB PhD FACHI said...

It seems to me that you can upload information to the NEHRS with a 'know address' approach - but what about information flows the other way - or is that all just look up and passive?

Surely an ELS is needed for any ad-hoc communication - e.g. to a specialist you have not used before etc?

Maybe we just ignore NEHTA SMD and leave messaging to the private sector while NEHTA / DoHA muck about with their expensive 'white elephant'.

David.

Anonymous said...

The pcehr never has ad-hoc communication out to specialists for instance. If information ever does flow that way it is in response to a request in which the return path is known. (that's as far as I know - I'm not actually doing any pcehr work so I am ready to be corrected).

Private sector messaging would be great - except for 10 years none of the private vendors could send messages to each other. So let's not pretend it was some sort of messaging nirvana out there. But they seem to be cooperating now so perhaps we can leave it to the private sector.

Anonymous said...

Three of the vendors in the messaging space(DCA/Argus, HealthLink and Global Health) have begun working together to enable messages to be interchanged. This uses the SMD standard as a common transport protocol.

Anonymous said...

Three of the vendors in the messaging space(DCA/Argus, HealthLink and Global Health) have begun working together ............

because the are now threatened by NEHTAs presence. It is amazing how they suddenly cooperate when they fell threatened - remove the threat and they will re tun to their old ways of competitive non-cooperation. Perhaps we need NEHTA after all !!!!

Anonymous said...

"Perhaps we need NEHTA after all !!!! "

Well maybe what we need for a fraction of the price is funding directly to vendors to achieve desired goals by funding outcomes!

A fraction of what has been spent could have been used to fund outcomes by vendors and standards. I think this is the correct route.

Government competing with the companies it relies on for tax is completely dysfunctional behavior. The Kiwis have the right idea here, they fund local companies (often at the expense of overseas companies) and they have a thriving e-health industry bringing in overseas revenue.

The sooner we rid ourselves of these pretend government developers and their service consultants that kill the goose that lays the golden egg (company taxes) the better.

I believe the US approach is correct here, fund outcomes from within industry, not empire building withing government.

There are numerous examples of where government funded projects die on the vine and become unsustainable orphans. When will we learn ??????

Anonymous said...

When will we learn ??????

What you fail to appreciate is that there is a deeply hidden agenda behind NEHTA directed at being the centrepoint of control. The only winner will be IBM when it sells a massive mainframe to support this central control approach. Neither NEHTA or DOHA are in the least bit concerned if a few small local companies hit the wall if it helps in leading to central control.

Anonymous said...

A few small local companies will not have the slightest concern when NEHTA hit the wall either. They will collapse under their own weight if we give them enough rope.

Anonymous said...

If one takes the position that tax-payer money should be used to fund private vendors to develop eHealth software, then the question is how to get the best value. Surely this is not to follow the US approach whereby scores of vendors are paid to develop functionally-identical software components in a feeding frenzy dressed up in the title of 'Meaningful Use'?

Anyway, Meaningful Use of what? A health system that results in up to a million person bankruptcies per annum? It must be wonderful to be shot in a cinema and then wake up to a 2.5 million dollar hospital bill!

Anonymous said...

Taxpayer money should be used with absolute integrity and judgement based upon a clear idea of value for the taxpayer. Value is not obtained by stiff-ling innovation and specifying a restricted solution of a central database that is nothing more than an overblown content management system with register only capability? How did that happen?

We need to fund outcomes by specifying what we want, not specifying how to build it. I don't think arguments about cinemas have any relation to the specification of meaningful use, you can't argue with the principle of specifying what not how!

Many government engineering groups operate still by specifying what they want and letting tenders for the existing market to be bid in a competitive manner. But the tenders they let referred to specifications for products using British (BS), global (ISO) or Australian Standards.

We need to get back to good engineering practice in this, not the dream it up nonsense from individuals that for the main part have never built and maintained a piece of software themselves. But worse, ignore those that have and do!

Before we argue about minutia, lets look at the big picture, ...

How much have we spent?
What have we got?

Too much, too little say I!

Anonymous said...

You ask - How did that happen?

This is how it happened. They started out thinking they could develop the all encompassing perfect system before anyone else in the world. Despite strong warnings from experts outside the tent they surged ahead. The deeper in they got the more they lost their way.

Then they opted for a compromise solution, something they saw as being much easier to do that would enable them to be the umpire and control the centre of the playing field. Once again the deeper in they got the more they lost their way. Still they refused to listen to experts outside the tent.

They continue to push on regardless believing that if they can secure a strong foothold with the Orion Singapore Accenture solution they may yet save their skins and be able to modify 'that' solution at a later time to give them a solution controlled centrally over which they can continue to exert their influence.

Their fall back strategy is that if all else fails they will exit the game via some sort of privatisation pathway just like DOHA has done twice before.

Anonymous said...

trust me - i'm a non-profit