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Tuesday, October 21, 2008

Health IT Standards – The New Zealand View.

The following announcement of a workshop a day or so in New Zealand attracted my attention.

HINZ 08: HL7 - Future Directions for New Zealand

11.30am. Dougal McKechnie introduced the panel discussion about HL7 and health IT standards and how they should be used in New Zealand.

The National Institute for Health Innovation was commissioned to produce a document on HL7 and other health IT standards: Strategic Directions for Health Informatics Content Interoperability in NZ.

Dr Douglas Kingsford is one of the authors of the report with extensive experience in the area health IT standards and presented a summary of the findings:

The report identified some key health IT drivers:

  • quality of care delivery
  • patient safety
  • cost of care delivery
  • shortage of skilled healthcare workers
  • public health
  • biomedical research

There already substantial benefits from simple interventions such as human readable EMR content and simple decision support. There is a movement towards more advanced technology including complex decision support and personal health records.

Interoperability can be divided into functional interoperability (negotiated exchange of information) and semantic interoperability (exchange without prior agreement).

Semantic interoperability needs:

  • common semantics (reference model)
  • equivalent formal datatypes (number of different standards)
  • means to define / constrain compositions (templates and archetypes)
  • agreed interchange format

Other considerations include messaging versus persistence and implementation.

More reviewing the standards options and a record of some discussion of the report is found here:

http://nihi.net.nz/2008/10/16/hinz-08-hl7-future-directions-for-new-zealand/

The report itself can be downloaded from this link.

http://www.hisac.govt.nz/moh.nsf/pagescm/7442

The program of the whole Health Informatics NZ (HINZ) conference of which this was a session is found here:

http://www.hinz.org.nz/page/conference

The report document provides two very useful sets of information. First it reviews where NZ is up to with health messaging and general Health IT Standards and second it provides a clear analysis of each of the different approaches being adopted.

I found sections seven and eight of the document ( pages 12-16) invaluable as what was concluded is that the answer has not yet become clear and that close observation of global trends will be vital.

This finding confirms the cautious recommendations made by DH4 to NEHTA a few years ago. (February 2006).

See:

http://www.nehta.gov.au/index.php?option=com_docman&task=doc_download&gid=68&Itemid=139

The bottom line here is that the answers as to the value of approaches beyond basic messaging with HL7 V2.x are still to be confirmed and that the relative places of openEHR and HL7 V3.0 as EHR standards are still to be fully clarified.

While it would be nice to have a clear way forward – but sadly the answer is ‘not yet’. More work, more implementations and more time is needed.

Both these documents need to be in the library of anyone interested in the EHR Standards domain.

David.

3 comments:

Anonymous said...

This simply serves to demonstrate how deeply flawed is the ivory tower mentality so prevalent around ehealth in Australia. A mentality which has been driving the ehealth agenda for seven years or more - first with HealthConnect and the BMMS which both failed, were then merged, then submerged, until finally surfacing as NEHTA.

Over all that time and after well over $100+ million dollars later we are still witnessing a mish mash of activity, poor decisions, shallow consultations, little or no engagement with industry and the misguided belief that the new program of Clinical Leads will build momentum and overcome 'user' resistance and scepticism, even although NEHTA has little to offer and no compellingly clear strategy in place to convince clinicians and anyone else that it is worth listening to - let alone investing in.

Anonymous said...

Imagine what could have been achieved if that $100M+ had been divided up between 50 health software vendors. Do the sums 50 x $2.0 Million = $100 million. Taxpayers - cry your hearts out.

Anonymous said...

I guess we'd then have 50 more software products that couldn't interoperate...
It all depends what problem you are trying to solve - until Australia commits to (and is prepared to fund) an e-health strategy that defines a goal state it is not be possible to meaningfully assess any approach.