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Wednesday, March 31, 2010

ArgusConnect Asks Some Hard Questions. Some Clear Answers as to Intent Would Help!

The following was released by ArgusConnect today – March, 31, 2010

Over 11,000 users and a new Division of General Practice

In March ArgusConnect passed the milestone of more than 11,000 healthcare practitioners using Argus for secure exchange of clinical information.
We were also happy to welcome the Central West Gippsland Division of General Practice (CWGDGP) as the 63rd Division of General Practice to join the Argus Affinity program to promote secure messaging connectivity between health providers.
73% of Argus users are GPs and the rest made up of Specialists, Allied Health practitioners and a range of other healthcare organisations.
Even though the first flush of the eHealth PIP-driven installations has now passed, registrations of practices requesting Argus installation has continued unabated. In 2010, we are still experiencing new site requests at the consistent rate of just under three practices per day with almost equal proportion of these being GPs, Specialists and Allied Health practices.
The high ratio of Specialist and Allied Health practitioners is very gratifying as it confirms our experience that the use of secure messaging is maturing whereby each sector of healthcare is realising increasing benefits and efficiencies from messaging. There is also maturing of user recognition that all users need to contribute towards the expenses incurred in development, installation and support of the messaging solutions that deliver those benefits and efficiencies.
The hard yards in getting GPs, Specialists and Allied Health practitioners to adopt secure messaging and use it for the first time is being put in by companies such as ArgusConnect, Medical Objects, AllTalk and others. In our case we have greatly valued the assistance and contribution made by many dedicated staff in Argus Affinity GP Divisions/Networks across Australia who have not only encouraged take-up by their GPs but also promoted secure clinical communications with Specialists, Allied Health practitioners and hospitals in their areas.
This has been achieved in spite of the fact that across Australia only a very tiny proportion of total Government eHealth expenditure has found its way, largely indirectly, to the messaging vendor industry or to Divisions of General Practice to facilitate implementation of this basic eHealth foundation.
We believe that this all debunks the myth within some parts of eHealth governance that the 'secure messaging industry' is the stumbling block to progress in eHealth. Credit should be given where credit is due and NeHTA, the State Health Departments and the Federal Department of Health and Aging should better recognise and support the contribution made by the messaging vendor industry, the early adopter healthcare practitioners and the sponsor Divisions to pave the way such that those who propose eHealth reform can work in a compliant and more mature environment.
Media contact: Mr Ross Davey, CEO ArgusConnect
ph: 03 6335 2220
Obvious questions flow to mind, especially in the light of the apparent plan from NEHTA, recently made public on this blog, to aim to deliberately displace Argus everywhere.
See here:
Questions include:
"Who is really the bogie man? The messaging industry that has done so much or NEHTA that has delivered so little – at least so far?"
"Why are the State Health Departments trying to harm the present messaging industry with NEHTA and Standards as the 'cover'?"
I know, from discussions with most of the major secure messaging providers, that the alarm expressed by Argus in the way they are being treated is by no means a unique view. It is pretty much a totally shared view.
Everyone in the e-Health sector should be alarmed by this sort of oppressive behaviour from a government funded entity like NEHTA.
David.

23 comments:

Anonymous said...

A few points...

- Argus has no idea how many people are using its software. Having it installed in a practice with 8 doctors doesn't = 8 users. That aside, they (and other messaging vendors to be fair), have quite poor coupling with clinical software...decent ACK handling is seen as on optional extra which is pretty scary! To call it secure messaging is a bit of a stretch.

- You can't claim to have roped in 63 divisions to do your marketing and deployment and claim to have minimal government assistance. Many of these well intentioned but ultimately clueless divisions gave preferential treatment to Argus because it was FOSS, however I believe the new version is now commercial with no FOSS option. Picking winners is never a good idea you dopes!

- It was the NT government's rampaging Stephen Moo who decided it would be a good idea to contract a developer to use draft standards (developed for free, largely by the vendor community) to build a solution for the NT...I cringe when government uses its fat bank balance to compete with the free market, however there were real operational problems with the way Argus works that had to be overcome one way or another. In short, tightly integrated web services were always going to leave third-party bolt on messaging solutions at risk of obscurity...we are seeing the beginning of the end on that front, partly thanks to the vendors themselves who did NEHTA's work and developed a standard that any of the clinical software guys can integrate into their solutions. Won't happen over night, but it will happen.

Dr David More MB, PhD, FACHI said...

Strong opinions are better with a name attached.

David.

Anonymous said...

The idea that people "use" messaging software overstates how e-messaging works. It is supposed to function invisibly, as an infrastructural service. If a messaging product is installed in a practice, it controls the flow of messages to every person in that practice. Hence it is not a stretch to claim that all 8 doctors in an 8 doctor practice are "using the software".

Finally, as far as I know, transport ACK responses to HL7 messages are a standard feature of the Argus program. I don't know how it deals with application ACKs to mitigate the shortcomings of clinical systems in this area.

Ross Davey, ArgusConnect said...

Agreed. Strong unsubstantiated statements made anonymously suggest that the statement is by someone that does not want their identity known. One is lead to ask why?

I will address one point: 63 Divisions have undertaken to put real effort into providing assistance to their members to embark upon using worthwhile ehealth functions so that their GP members can gain real benefits in their day-to-day work. It is mean-spirited to accuse them of being 'roped in' and 'clueless' and 'dopes'.

My experience is that the most active Divisions in this area have GP members that are appreciative of their efforts and their work in their behalf. They have at least put effort into making a difference on behalf of their constituency and they have lead from the front.

The nature of these comments only reflects badly on 'anonymous'.

Anonymous said...

I agree with anonymous - meaningless stats with no indication of how it is being used. No mention of HealthLink who have far more installed clients.

This is just a contest of self-publicity and cries for protectionism in the face of better products.

The woe-is-me schtick gets a bit tiresome.

Tom Bowden said...

While I am not rushing to the defence of Argus, I would like to make three points.

1. We have been integrating health systems in primary care for 15 years. It is true some of the technology could do with an uplift, that is why we are implementing web services and where possible NEHTA standards. Over that 15 years we (and companies like us)have made a major difference to healthcare IT especially in environments that are reasonably condusive. Australia to date has not been. Vested interests, complicated/dirty politics and little leadership have made it an uphill struggle.

2 Returning to environments that are condusive to making e-health progress; we have become a Health-system Integrator, messaging while still important and growing strongly is ony about a third of our business. As a health system integrator we are implementing online referrals (web-services based), electronic pathology and radiology requesting, etc, etc and we are performing all manner of regionally based services. We also answer approximately 3,000 help-desk calls per month, many of them from across Australia.

3. With respect to Mr Moo and the NT activities, that is interesting, however, improving the way a few basic messages are sent from A to B doesn't change anything that much. We have all done that at some time. What Australia needs, same as every other health system, is an environment in which companies such as Argus and our own can work in partnership with the health communities and government to deliver a Health-system Integration framework.

In any event, we are just getting on with it, there are lots of people who do 'get it' and we are working with them.

It does disappoint me though that people fail to try and grasp these issues and then denigrate those who have been working very hard for years. They should be trying to make it easier for them to do the job, not harder.

Oh yes, Annonymous, how about telling us who you are. Lets have the debate out in the open or are you just one of those shadowy figures who wants to see the problems perpaetuated, to the great and real cost of the taxpayer and the patient.

Australia's e-Health environment is a laughing stock on the world scene. Lets actually work together collaboratively and do something about it.

Tom Bowden
CEO of HealthLink
Australasia's leading Health-system Integrator

Ross Davey, ArgusConnect said...

Perhaps aa approriate day/date to respond to 'Anonymous (2)'

>meaningless stats with no indication of how it is being used.

As you should know, Argus is point to point and hence to date has had no means of monitoring traffic. So stats have been hard to achieve. However Version 5 (that was announced yesterday) does have a sophisticated statistics-gathering capability that can be used by Divisions and stakeholders (with practice consent) to gather de-identified message stats data. That information will be fascinating to us as well as many others.


>No mention of HealthLink who have far more installed clients.

No and I didnt mention eClinic and a number of others who have also been doing fine work. Give me a break!

>This .....cries for protectionism in the face of better products.

Where in the media release is there any mention of wanting protection? It simply makes the point that some people have been doing exceptional work to get eHealth going and they should be supported and their efforts recognised.

>The woe-is-me schtick gets a bit tiresome.

Where in the media release is there any 'woe-is-me'? I dispare when I read such sweeping and glib arguements!

Anonymous said...

So, where is the NEHTA web services standard secure messaging system successfully operating now?

Anonymous said...

Ross Davey, ArgusConnect said...
“63 Divisions have undertaken to put real effort into providing assistance to their members to embark upon using worthwhile ehealth functions so that their GP members can gain real benefits in their day-to-day work. It is mean-spirited to accuse them of being 'roped in' and 'clueless' and 'dopes'.”

Ross is so right - use of the terms 'roped in', 'clueless', 'dopes' is mean spirited. Let’s get things in perspective.

An opportunity arose, a marketing program was implemented, sales were made and ArgusConnect built a customer base. The customers had a choice, they could have gone elsewhere, competitors could have entered the fray to sell their products - but in the end the bottom line is the customer chose the ArgusConnect approach (rightly or wrongly is academic and of no relevance). The customer made the decision they thought was best for them. The successful sales person did what any good sales person does - completed the sale. If or when the customer is no longer happy they can opt to change direction, go elsewhere or gripe to the vendor to get their concerns rectified - a normal customer relationship management activity.

What is more telling however is not how many ‘customers’ ArgusConnect can lay claim to but how they are counted as one commentator pointed out. And more importantly in order for transparency and substance to underpin the ‘market penetration’ claims of one vendor or another they should all present their arguments using identical parameters for fair comparison.

We see little evidence of any major move away from ArgusConnect so the criticisms leveled by others to-date would appear to be rather shallow. In the absence of such evidence one has to assume their complaints are more vindictive than anything else driven perhaps by envy of a persistent competitor (Argus) who has secured a substantial piece of real estate coveted by others.

Anonymous said...

On the one hand “HealthLink who have far more installed clients” on the other ArgusConnect claims 63 Divisions of General Practice participate in the Argus Affinity Program.

All credit to Tom Bowden, Ross Davey and others who make an effort, wear the risks and try to move forward in the face of formidable obstacles more often than not created by bureaucratic meddling and ill conceived strategies to address the issues.

Perhaps this is too simplistic to be worthy of any consideration but ...... How about asking HISA to prepare a customer satisfaction feedback survey to be sent to every General Practice Network for them to send to each of their member practices to compete and return to HISA for compiling the results by State and Nationally.

ArgusConnect, Medical Objects, HealthLinks, ProMedicus.net, eClinic and any others should all be included.

Ross Davey, ArgusConnect said...

Great idea! I second that.
We were going to do one ourselves because customer satisfaction is vital to us. However a HISA one would be terrific.

Anonymous said...

It would be great to hear the same response from HealthLinks, Medical Objects and others.

Of course HISA doesn't need permission to do such a survey but I'm sure they'd welcome some more supportive comments.

Anonymous said...

Anyone? Anywhere? NEHTA's web services secure messaging standard in operation?

Geoff Sayer - HealthLink said...

Re Anonymous Thursday, April 01, 2010 1:07:00 PM: Don't have a problem at all for independent customer satisfaction. A company should be doing independent on their own company as well if they take their business seriously. HealthLink does that as well as routine feedback through other channels.

Re Anonymous Thursday, April 01, 2010 4:27:00 PM: I believe the answer is "No" - it may start to happen in simulation through the IHE Connectathon but out in the wild?

PS: Anonymous is a high frequency contribtor to this blog - does he/she have a regular job as well... Hopefully the HI Services can handle their identity appropriately and not mix tehm up with the other Anonymi :)

Dr David More MB, PhD, FACHI said...

Anonymi seem to be people who work for organisations who behave badly towards them if they are seen contributing to the conversation!

No names, no packdrill.

David.

Simon James said...

"Anyone? Anywhere? NEHTA's web services secure messaging standard in operation?"

Other than the solutions in the NT?

That is, an early draft of the work done by the MSIA and NEHTA was utilised to build the WSMA solution deployed in the NT by Pen and Communicare. I'm told by all involved that this WSMA component will be updated to adhere the final version that ultimately went to Standards Australia - haven't looked into these developments for 6 weeks or there abouts so not sure where these specific implementations are up to presently...I'll be revisiting in the coming months as my July edition will focus on Secure Messaging and electronic prescribing.

Jim Cocks said...

Anonymous (Thursday, April 01, 2010 9:28:00 AM ) summarises correctly:

“An opportunity arose, a marketing program was implemented, sales were made and ArgusConnect built a customer base. The customers had a choice, they could have gone elsewhere, competitors could have entered the fray to sell their products - but in the end the bottom line is the customer chose the ArgusConnect approach (rightly or wrongly is academic and of no relevance). The customer made the decision they thought was best for them. The successful sales person did what any good sales person does - completed the sale. If or when the customer is no longer happy they can opt to change direction, go elsewhere or gripe to the vendor to get their concerns rectified - a normal customer relationship management activity.”

From a GP Divisional viewpoint, the intent was to leverage ehealth awareness amongst our constituency by providing a tool which had immediate productivity benefits for them. In addition, we provided one of the most important components of successful take up, to wit training the user base, in most cases in situ.

We considered other products from a number of viewpoints which have been canvassed in this blog. We also invested a (very small) amount of funding in training local installers (including a number of private providers). The end result was an almost 80% takeup by GPs, and about 30% by specialists.

Whether or not the customer base decides to go to other options is hardly the point – the point is that usage of secure messaging demonstrates its benefits out where the action is in primary care. The advantages are even more apparent in rural and remote settings where the regional centre has the highest concentration of specialist resources – it’s a long wait for the post between Henty and Wagga.

It’s also pleasing to note that 2 of the major providers have announced a collaborative effort, and that at least one clinical software package (to my knowledge – there could by now be more) comes bundled with a secure messaging software suite ready for use.

Anonymous said...

Sunday, April 04, 2010 12:29:00 PM said "It’s also pleasing to note that 2 of the major providers have announced a collaborative effort, and that at least one clinical software package (to my knowledge – there could by now be more) comes bundled with a secure messaging software suite ready for use."

The collaborative effort referred to is between ArgusConnect and Medical Objects. That they have set the lead is far sighted and courageous and it is to be hoped they will continue to go from strength to strength as a consequence of doing so. Few seem capable of working together cooperatively in such a fragmented and contestable environment, yet, unless and until we see much more of this being done (which necessitates a complete 'change of atitude') we will continue to be pained and frustrated by the paucity of progress for many more years.

Who else can lay claim to having established a collaborative-consortium-like environment where 'competitive' organizations have chosen to genuinely share resources, skills and knowledge to solve some of the more elusive high priority issues discussed so often on this blogspot?

And why does not NEHTA step up to the late and support such an approach? Support alone is not enough, some funding is also required and with all the money being thrown around surely a little could be allocated to build such consortia. Are there any other developers prepared to form consortia and collaborate? Apart from the availability of funding the barriers to doing so, more often than not, lie in the egos of those who talk long and loud about collaboration and cooperation but who fall silent so quickly when the time comes to demonstrate they are prepared and 'able' to accept the compromises involved in doing so.

Anonymous said...

“And why does not NEHTA step up to the plate and support such an approach?”

That’s a good question. Why doesn’t NEHTA get involved in such initiatives? Does it have another agenda? It keeps banging on about supporting industry and working collaboratively with us vendors and it pushes its clinical lead program pretty hard, yet none of this has developed any traction. I don’t think it’s got anything to do with NEHTA having another agenda. Rather I think the reasons are firstly because NEHTA’s governance roots are in conflict with establishing such initiatives, and secondly because it is too difficult for NEHTA to conceptualise.

Anonymous said...

I think it more that "it is too difficult for NEHTA to conceptualise". Three years ago or thereabouts the idea of establishing one or more industry-initiated consortia between like-minded vendors was discussed but no-one showed sufficient interest to make it worth the effort developing the model further. Although some discussions followed with NEHTA and DOHA they didn't seem to comprehend and more recently a similar attempt by MSIA fell apart not long after it was established.

Anonymous said...

Rather than being a concept “too difficult for NEHTA to conceptualise” I would like to suggest it is more to do with an inadequate understanding by all stakeholders of the dynamics of what is required to make an “industry-initiated consortia” work.

It should be pretty obvious to all that the ehealth drive and energy is predominantly emanating from the IT industry, from the big technology vendors like Microsoft, HP, and Google and from hundreds of health software developers and associated enthusiasts. They all have a vested interest in pushing the ehealth agenda in order to grow their business.

The next level of drive is coming from public sector bureaucracy. They have been sold the benefits of ehealth by the vendors. So we now have the vendors and the bureaucrats marching to the beat of the same drum - almost. However the politicians are a lot more wary of all the blue-sky sales hype. They will listen politely to the vendors and the bureaucrats, but they will be reluctant to bite until it becomes politically necessary to do so. The politicians are listening for the consumers and service providers to convince them that is what they want. And so far we haven’t seen much pressure and noise coming from these quarters. We also haven’t seen too much pressure coming from the nominated spokes-parties for the service providers.

So despite efforts by the IT industry and the bureaucracy the consumers and service providers seem still to be fairly content with the status quo. If one accepts these dynamics are reasonably close to the truth then it will be clear that in order for an “industry-initiated consortia” to work effectively it is necessary to have the drive for such a project come from the customers who depend on the service providers. Regardless of whether it is in primary care, aged care, community care, or hospitals it is the patient (the consumer, the client) who must be deeply involved in driving ehealth and it is the service providers who must respond to that demand. Then the politicians will fall in behind the voters, the bureaucrats will adjust their position accordingly and the vendor community will fight over the spoils.

Within that context some user-initiated consortia of health software vendors might just work with appropriate support from other quarters. That shouldn’t be too difficult for NEHTA to conceptualise.

Ross Davey, ArgusConnect said...

David, can I suggest that you should remove the ability for people to just nominate a category or 'Anonymous'? If anyone wants to post without being identified couldnt you just allow them to use a pseudonym? Then it is easy to respond to 'Deep Throat' or 'Miss Piggy' and everyone knows who you are respoinding to.
It is so difficult answering 'Anonymous' by referring to their posting time and it is hard to follow responses to 10 different 'Anonymi'.

Dr David More MB, PhD, FACHI said...

Hi Ross,

As much as I would like to - sadly there are a whole heap of people who contribute whose jobs would be at risk if they were named and we would miss out on all sorts of interesting stuff - most of which is true. I do admit there have been examples that have been less than that - but they have been pretty few and far between!

David.