Over the last few years one of the very few success stories in e-Health has been in the area of secure messaging between healthcare providers – especially pathology and radiology practices – and their referring GPs and to a lesser extent specialists.
This messaging has been provided by a range of for (some variable amount of) profit (think HealthLink, Medical Objects, Promedicus, eClinic and so on) entities, and also some virtually non-profit (essentially cost recovery) entities (think ArgusConnect).
(I apologise in advance if I have mischaracterised provider’s status – let me know!).
Most have utilised HL7 Version 2 messaging standards with variable levels data content dis-aggregation.
ArgusConnect has also played a significant role in supporting developments with NT Health in its (still pretty embryonic) work in the Shared EHR and e-Prescribing.
ArgusConnect (http://www.medisecure.com.au/index.html) is also a key partner in the Medisecure e-Prescribing hub.
Additionally we have eRx (http://www.erx.com.au/) who is providing an e-Prescription hub with secure messaging.
From their FAQ they say:
What standards does eRx use?
eRx has adopted existing messaging standards through the use of web services technology, the utilisation of HeSA PKI certificates and conforming to privacy legislation. eRx will adopt to emerging messaging standards as they become available.
Now a month or so ago I published a blog pointing to some issues that were arising in the ePIP program the requires Secure Messaging to be on the agenda of software providers used by GPs for an additional and reasonably useful payment.
Well a new document has come to light from my various sources that rather makes it clear that NEHTA has been less than open with all those it has had working on the PIP Working group.
----- Begin Extract
NEHTA Web Services Messaging Application (WMSA) Project Plan – 30 Jun, 2009.
In the Northern Territory, secure electronic messaging underpins the following ehealth services:
- Shared Electronic Health Record (SEHR)
- Electronic Transfer of Prescriptions (ETP)
- Electronic Transfer of Referrals
- Communication of clinical information
Currently this messaging is provided by the Argus Messenger application which is a commercial messaging application installed at each of the participating sites. The Argus messenger application uses the Public Key Infrastructure (PKI) encryption and POP3/SMTP technology for the transmission of messages between a number of systems as well as from source systems to the SEHR. Source systems interact with the functionality provided by the Argus Messenger through a number of API’s.
The National eHealth Transition Authority (NEHTA) has developed a set of specifications for securely transferring health information using web services technology. As a result, to meet current and future needs in the
Initially this will be a generic web services messaging solution, however as NEHTA specify each type of clinical service, e.g. pathology required, pathology test results, discharge summary, referral, ePrescribing, etc, these will be implemented as discreet web services endpoints and the generic web services endpoint will be used for unspecified payloads.
The objectives of the WSMA project are to:
- Develop a secure messaging application compliant with relevant NEHTA specifications, utilising web services technology.
- Develop and implement a generic web services endpoint solution, which will later implement distinct endpoints for each clinical event as NEHTA specifies them.
- to replace Argus secure messaging systems for Communicare & Pen computing sites in the Northern Territory;
- to replace Argus secure messaging systems for the SEHR
The expected outcomes of the NT secure messaging project include:
- Successful implementation of a production web services solution for securely sending messages from Communicare & Pen Sidebar to the SEHR, which is compliant with the NEHTA specification.
- Future releases of WSMA will replace “Argus Messenger” at all the NT DHF sites
- Addressing current administrative and performance issues associated with the Argus secure messaging systems.
- Provides a platform on which further interoperability initiatives such as identity management (UHI, ELS), electronic referrals, discharge summaries, etc can be leveraged.
- The IP for the software developed in this project will be owned by the Northern Territory of Australia, and will be made available to other jurisdictions under open source licence the details of which will be defined later. It is envisaged that WSMA will be progressively deployed across other jurisdictions. (Creation of an open source .NET SDK for use by other Jurisdictions e.g. SA Health)
- Cost savings as sites are expected to require less administration and maintenance as well as the removal of the reliance on commercial messaging systems.
----- End Extract.
So what we have here is essentially NEHTA and the Jurisdictions all but declaring war on, and planning to replace, the current messaging providers for totally unclear reasons – especially when this area is one that has been gradually improving and where there has been co-operation to a considerable degree – unpaid – between NEHTA and the messaging providers.
It seems its Argus for now but essentially all commercial messaging system are on the nose as far as NEHTA is concerned. Sadly the plan offers no clues as to just how such replacement might work and just who would provide the hand holding and support that is needed in this sector. Is NEHTA wanting to get into messaging support? I think not!
This has a very much the flavour of a ‘my way or the highway’ approach from NEHTA that I cannot imagine will be well received by the vendor community.
Sounds like NEHTA has been playing both sides of the street and I would be surprised if there are not some commercial or legal outcomes of all this.