NEHTA Releases A Specialist Letter Package. Does it Add Much?

NEHTA have very recently released a package of specifications on Specialist Letters.

Specialist Letter Package

The Specialist Letter Package builds on NEHTA’s ongoing eReferrals work and closes a vital communication link between general practitioners and non-GP medical specialists. The Specialist Letter provides a standardised national approach to sharing these key clinical communications and allows for a narrative to be included as part of the letter.

What is in the draft Specialist Letter Package

NEHTA is now seeking your comment on a draft package of documents that defines the clinical business requirements and content of a specialist letter message. The package includes:

1. Executive summary.
2. Release notes – a summary of changes made to the document during earlier review cycles.
3. Business Requirements Specification – a description of high-level requirements, business models and use case descriptions for specialist letters. This document outlines the specifications and guidelines to be adopted by implementers when developing nationally-interoperable referral solutions within the Australian healthcare community.
4. Solution Design Specification ‑ defines the technical environment and is developed for the people who will build the infrastructure and the software.
5. Core Information Component Specification ‑ defines the minimum set of data that is recommended for implementation in a system that creates and exchanges referral information within Australia.

How to be involved

NEHTA is requesting feedback from national stakeholders. The consultation period is open from Friday 25 March until Friday 27 May 2011.

The link to the site is here:

http://www.nehta.gov.au/e-communications-in-practice/ereferrals/specialist-letter

Now I have to say that I see the specialist letter back to a referring practitioner as one of the most valuable pieces if clinical information one has on most patients - especially if it comes from a specialist physician.

The reason for the importance is that typically a physician will take a significant period to time to talk to, examine and investigate a patient. In documenting the encounter they will then produce an invaluable summary of the entire medical history and current situation. Done thoughtfully in the calm light of day this report back to the referrer is really a vitally useful clinical document.

Given the clinical value I see secure transmission around the health system of these documents electronically as crucial and vital.

I have had a browse of the 5 components of the package. My overall impression is that it is really not a great leap forward. Amazingly the Business Requirements Document reveals it has taken a full year to get the documents to this point and the whole issue is really pretty simple!

This slowness has meant that components that were meant to be released in 2010 are yet to see the light of day - see numbered page 1.

The good news is that the work has been released in draft with a reasonable comment window. Yeah!

I guess what amazes me is how NEHTA persists in maximising the complexity of moving forward.

While there is clearly sense in having the electronic specialist letter having all the necessary identifiers and contents fully defined and codified in the long term would not a good first step be to use simple messaging containing the basic header information and a .pdf or .doc of the actual letter to get information flows started.

I think this is what is talked of as the current state in the Solution Design Document.

Quickly NEHTA then seems to move to its idea of the interim approach with HL7 CDA, Terminology and a much for complex structure.

The future state then adds a whole lot more with HI Services, NASH, Endpoint Location Services and so on.

In summary this is a roadmap with no time-frame attached. What I would like to see, as a first step, is access to the current state fully implemented for all clinicians and then incremental moves forward. By taking the long view we keep ignoring those who have not yet started the journey and need to be got going. Certainly there are more than a few specialists in that category.

So, kudos for seeing and recognising how important the Specialist Letter is and brickbats for again not sponsoring an incremental improvement approach bringing along all users.

After reviewing the 4 Cornered Presentations regarding the PCEHR is it absolutely obvious that if anything is to be going by mid-2012 then the KISS principle will have to be rigorously applied. This document does not really reflect any understanding of that reality as neither do most of the present NEHTA specifications.

David.