Friday, April 28, 2017
A Really Long Saga That May Just Have A Happy Ending For Secure Messaging, Or Not.
This appeared a few days ago.
The wonders of modern digital connectivity are there for the taking, but there are elephants in the e-waiting room
21 April 2017
This is one of those stories that as a GP you won’t, on spec, be interested in. But only because you’ve never been told “what lies beneath” the story: the unnecessary, and potentially significant, retardation of better communication between the various important hubs of health information in this country, and therefore the slowing of delivery of much more efficient healthcare, via GPs, to their patients.
Ask most GPs what they think of the big private pathology providers and your response will be usually be somewhere between indifferent to unusually positive. One GP we asked is literally thrilled with the new mobile results service that Sonic Healthcare now provides through its path labs. To GPs, path results arrive through their patient management system with relative ease. What is there to be bothered about?
If you ask a practice manager, or a practice IT contractor, you get a degree more of concern, but still nothing catastrophic. The issue for them is there are so many different systems talking to their patient management systems. That is a hassle, but once they are downloaded, they are usually robust and work. Some combinations still won’t work, however, no matter how hard you try to jam them together, and so, in some cases, the IT manager has to buy in another messaging solution, or develop a costly and frustrating workaround.
The problem is, unless you’re an immersed GP owner, or one of those GPs who are into their IT systems, you never see these issues, and generally won’t be aware of the additional cost. Over time, there is a lot of additional cost.
For the majority of GPs, these gateways are magically working, so never given a second thought. Which is normal behaviour. Does anyone know how their mobile phone works, or how Facebook targets those ads at you?
This article is largely about you giving everything that happens down the messaging and IT interoperability rabbit hole a second thought. Because our whole healthcare system is being slowed down currently by what is a mess of spaghetti-like communication protocols, that don’t talk easily to each other.
This situation has been created by a mix of poor planning, ineffective regulation, vested interests doing what they do best, and bad luck.
Here are a few things:
• The messaging systems of the major private pathology providers are antiquated and proprietary. They aren’t up to the messaging standards being laid down by the government for a modern e-health messaging environment, and, in some instances, they aren’t even secure to the standards required. Also, there are lot of them, and they still change from time to time and remain proprietary and basic. In the case of Primary Health Care, the system can be dependent on which region you are in and the labs that are serving that area.
• Add to this a host of private, independent messaging systems, such as HealthLink and Argus. They are often a little more interoperable, secure and can provide better sources of data analysis if you want to tweak a system, but they, too, don’t talk to everything. Part of that is that the private pathology providers don’t want to talk to them, because if they do then these independent providers can move in on their referrers more easily and facilitate easier change of pathology providers. So long as they don’t talk to the private path systems, these independent systems aren’t that efficient either, so they never get to take hold of the system, like they have in NZ.
• The effect of this, and other techniques used by the big pathology providers, such as pre-printed branded and bar-coded pathology forms for doctors to use, and buying up all the real estate in large practices where pathology can be co-located, is that these big labs can stay more strongly attached to their referrer base – which essentially is you, the GP. They want to be very sticky to you because you are their reseller even if you don’t realise it.
• The result is you don’t have any hassles, so you don’t question anything and patients don’t know they can use alternative pathology providers. So the big pathology labs hold on strongly to their long term client base.
• But it’s what you don’t get that might be hurting you. Reverse the saying, “You don’t know what you’ve got till it’s gone” to “You don’t know what you’re missing until you’ve got it”, and you might start being a little more interested. No one is telling GPs what they might be missing.
Lots more here:
The rest of the article makes a great read so is worth it. The only point I would make is that it seems the GPs who work with Sonic and Primary seem pretty happy and lack a major stimulus to change.
While that is the case you can be sure commercial interests will prevail and little change will result unless there is a buck in it. It is up to the Government to work out just how much the really interoperable system is worth to them, or alternatively to attempt to mandate a solution – which you can be sure will be less good than incentive driven one.
Somewhere in the middle is the sweet spot I reckon! Note that Jeremey also has some commercial interest in the outcome of all this I believe.
p.s. In full disclosure mode, I have a few Sonic shares.
Posted by Dr David G More MB PhD at Friday, April 28, 2017