Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, June 14, 2018

Does Anybody Know Where This Is Actually Up To Now We Are Into June 2018.

This popped up a few days ago:

Australia to create a connected health service through the National Health Interoperability Roadmap

By: Teresa Umali
Published: 4 Jun 2018
Interoperability is an ongoing issue in an individual’s health record information. With the information fragmented across providers, some even stored as hard copies or scanned copies, retrieval of which becomes difficult especially during critical times. With the development of a National Health Interoperability Roadmap by December 2018, this can be solved.
An announcement from the Australian Digital Health Agency highlighted the government’s plan to connect health services all over the country through the National Health Interoperability Roadmap.
The process of easier access to health service records is about to become a reality. The National Health Interoperability Roadmap is on its way.
Interoperability among systems is an ongoing issue. Information on an individual’s health records are distributed and saved on different health facilities systems across the country. And they are stored as hard copies or scanned copies. Thus, a consumer does not have ready access to records as well as who can manage and access them.
Digital health has enormous potential for all Australians. However, this potential cannot be fully realised while information remains fragmented across providers. Work should be done in order for the different parts of Australia’s digital health system to work together. Interoperability, the ability to exchange information, should be achieved.
Some of the building blocks are already in place. My Health Record provides both a vehicle and a defining framework for the sharing of key information. Also, sharing information between providers who have a clinical relationship to each other and a shared patient are also being used. An example of which is pathology laboratories providing information back to referring GPs in highly useful electronic formats.
Lots more here:
We only now have about six months to go. I wondered, given the lack of Board Minutes and the like, if there is any progress to report?


Anonymous said...

Reading that they are clutching at straws and have no understanding or appreciation of interoperability.

Anonymous said...

1:08 PM. As with the ADHA this article seems more inline with integration rather than interoperability. ADHA is bound to the MHR which is constrained by system integration and middleware. The ADHA is strangely much like the fax as their CEO describes it

Dr Ian Colclough said...

Interoperability Has been an issue for a decade or more and this will continue for many more years in regard to the shared, electronic, health record. There's a huge amount energy being focussed on the issue commensurate with a lot of noise and hype by numerous projects around the globe aspiring to solve the 'problem'.

As Bernard R-D says -- What is the problem everyone is trying to solve? I have to agree with him. The problem is not interoperability and therein lies the rub. I've not seen any document by Nehta or the ADHA which precisely and unambiguously defines the problem they have been trying to solve. Certainly, there has been an abundance of unsubstantiated claims intertwined with truckloads of marketing messages and motherhood rhetoric but nothing that I have seen which crystallises the 'problem'.

Perhaps this is because the 'agenda' has been and continues to be driven by enthusiastic technologists intent on developing 'solutions' to solve problems which have not been defined! !!

Anonymous said...

@ 4:45PM It's not just technologists driving the Agenda. You must add to the mix Peak Bodies, like AMA, RACGP, etc. as they too stick in their two bobs worth without having much of an idea about the problem to be solved. The general idea is that the more ideas everyone can contribute, one way or another, including feedback gleaned from focus groups, the greater the mish-mash for the technologists to work with.

Anonymous said...

I believe the problem is the fax, that old devil that regardless of the carrier, regardless of the hardware or software vendor you can send messages large and small, knowing that the reciever is getting an exact copy of what was sent, warts and all. Oh and it does not need to have paper involved is you chose not to use it

Dr Ian Colclough said...

The fax is not the problem. It is just a piece of antiquated technology that some find useful. Although, believing that it is simply reinforces my 4:45 PM comment.

Anonymous said...

My reading of "the problem is the fax" is the fax is so good at what it does that coming up with a better solution is difficult.

Andrew McIntyre said...

Without interoperability at the messaging level, which is actually proven to be able to handle standards compliant messages, the implementation of messaging at the moment would result in fax machines that delete pages, turn themselves off if they receive certain documents and randomly shred some pages, while dropping lines here and there.

Until we have a proper compliance regime for receivers to ensure proper display and handling of clinical data, clinical safety will be under threat. We need message interoperability before messaging interoperability is a safe option.

Anonymous said...

OK, that said Andrew, may I ask what is ADHA doing to ensure we have "a proper compliance regime for receivers to ensure proper display and handling of clinical data"?

Also, apart from the ADHA, what other work is being done to deliver "proper compliance regime for receivers"?

Andrew McIntyre said...

I have made the effort to meet with every "leader" of national eHealth bodies over the last 10 years to try and get them to address this issue. The current one didn't turn up but his 2IC did. So for the 4th time an increasingly strongly worded message has been delivered, but we are yet to see a response.

HL7 Australia have produced a new standard and we have developed some compliance tools at "https://hl7lint.medical-objects.com.au/" but compliance is a low priority for people who are implementing software, as their customers wants come first unless someone gives them a good reason to do the work to actually test compliance.

Grahame Grieve said...

"as their customers wants come first" - this is a key comment from Andrew. Customers do not want to spend any money on interoperability conformance. I'm still not sure, after 20 years, exactly why it is they bitterly complain about the outcomes of their own lack of willingness to spend on this - how do we break that cycle?

Note that MSIA took the problem on.... but that didn't go anywhere either. I'm not sure why that fizzled out too, unless it comes back to the same thing:

- vendors spend money on what their customers pay for. And that's not interoperability conformance (why spend your money on not having something?)
- the customers don't know why or how to buy interoperability conformance (and settingup a lab didn't help)
- the government doesn't know why or how to shift the market
- the vendors complain about the situation too, but haven't moved the market either
- the professional associations all do it too.

A few things are working... FHIR is one of them, but it's not influencing the market. Yet. (And I want to change the game - we're coming to that point...)

Anonymous said...

We’er coming to that. Grahame be careful not to get sucked into the promises of replatforming. All that is happening in an end of a contract period. Government requires that an open tender process takes place. That is no guarantee anything will change and looking at the way the economy is going I don’t think they will be throwing a hundred million to change platforms and migrate data. That age of the central database is over.

Interoperability will mostly take hold at a localised small community, where actors will come and go dependant on the need. Perhaps the problem is to much information is being pushed to everyone creating so much noise it’s either worthless or creates uncertainly it’s that data relevance or clarity. Being able to obtain the right information at the right time for valid purposes is probably more helpful..

Anonymous said...

Grahame your comment "Customers do not want to spend any money on interoperability conformance" is absolutely spot on.

The HI conformity testing is a classic example with lofty goals by NEHTA and industry at the time. Fast forward a decade and only one independent NATA test lab still doing the testing (the other dropped out - lack of revenue). talk to the remaining lab and they will tell you all their HI revenue comes indirectly from ADHA via payments to vendors.

And its not like DOHA/ADHA actually care about interoperability - the test lab is just an inconvenient obstacle standing in the way of integrating more systems to MyHealth.

Anonymous said...

Customers do not want to spend any money on interoperability conformance

Perhaps they expect that to be part of the package. Have the customers been asked where they want to see Interoperability? And which customer?
While the thinking is around vast amounts of people doctor shopping and seemingly on endless travels to far flung places, which is rare and not some most people find immediate to their life experience.

Enable communities of care around existing relationships, patient-GP-local path- local specialist- local hospital sort of thing, where trusted access to and sharing of information is not a permanent state. There are ways to enable emergency service when required to aces information if needed.

The mindset where everything is stored in some mammoth database is outdated, sticking it in a ‘cloud’ makes no difference.

Andrew McIntyre said...

The usual question is "Do you support HL7" and the answer is yes. The problem is that good quality standards compliant messages are not plug and play and the only way they will become that way is for receiver compliance to be tested, which is not a difficult thing to do, but fixing the compliance issues will expose deeper software issues and it will take resources to fix those issues.

The only way to elevate those fixes to "do it now" is to impose a requirement for compliance 6-12 months down the track and say if you don't have it you can't receive electronic results. There are real patient safety issues and no one can produce a single compliant message and have confidence it will work at the other end.

Receiver software is like a fax machine, you should be able to plug it in and know that it will receive faxes reliably. I am sure this probably wasn't the case initially but they now have to pass tests to enable connection to the phone network, and so should medical software. Then its possible to insist on sender compliance and messaging interoperability becomes realistic.

This compliance has nothing to do with the MyEHR, its for reports and referrals travelling between providers, which has been neglected.

Dr Ian Colclough said...

@9:33 PM Andrew said "The usual question is "Do you support HL7?"

This is a challenging conversation which should be fleshed out further. Perhaps it would be better to rephrase the question Andrew given previous comments. Would it be more appropriate to say "Do you support the combination of HL7 and FHIR as an expedient way forward? Do HL7 and FHIR complement each other or would one impede the other?

Andrew McIntyre said...

I guess they are both HL7, but "HL7" usually implies V2 as that is what is in common usage, and CDA does not really have a future, but is also a HL7 standard.

For new things like the Provider directory FHIR has been used, but there is a lot of lab and clinical data in V2 and that is unlikely to change in the near future so compliance with whats in use is the appropriate strategy for guarding patient safety and enabling free transfer of information between providers.

Its possible some of the existing things will migrate to FHIR in time, but that is uncertain. If it is used it should also have a compliance program. We are using V2 and its a critical part of healthcare now and should be high quality for safety reasons. I dislike excess compliance regimens but its clear that we need a governance element to actually make it happen.

Its an amazing oversight in reality, the level of compliance for things like day surgeries extends to ridiculous details, but the patient information that decisions are made on can be hacked together by anyone and displayed in very haphazard ways and no one is remotely interested in making sure its safe. I know that in reality its not safe currently, its held together by brown paper and string.

Grahame Grieve said...

@Ian when Andrew said "Do you support HL7?" he was asking a technical question about the product, not in terms of a strategic way forward. And he's right - mostly, support for 'hl7' is relegated to a single tick in the box, and ticking it provides no assurance that it will actually work.

MSIA did kick off a project to actually work on this. Andrew and I were both involved. We all sat down and drafted the rules that we actually wanted for interoperability. Andrew & team brought forward most of the technical issues. After the meetings, I wrote a formal detailed technical specification that we had all agreed to and could have tested against... so all the tech was in place. But then, it went nowhere.... because solving the technical problem, though a precondition, isn't the actual answer.

Dr Ian Colclough said...

Andrew @2:21PM has summarised the situation eloquently and succinctly. Grahame @3:02 PM 15 June has also provided some powerful 'insights' deserving of deep reflection.

It would be helpful if Grahame could comment on whether he is in agreement with Andrew's 2:21PM comment or where he might differ and why.

Anonymous said...

Maybe HL7 Aus could publish a product strategy, some guidance on how these various HL7 standards can co-exist, how over time investments could best be made for co-existence and what might be some transition strategies is people were to invest in moving from one standard to another.

If HL7 Aus is the technical application and rightfully so then ADHA as the national entity could then focus on the other elements, like funding models, business agreements, people factors, semantics etc...

Dr Ian Colclough said...

@3:07 PM Illuminating comment Grahame, thank you. You have prempted my 3:47 PM entry above. In doing so you observed that "Solving the technical problem, though a precondition, isn't the actual answer." I, and I'm sure Andrew, and I suspect Bernard R-D and John Scott, all agree with that sentiment.

That leaves one pondering ... What to do?

Bernard Robertson-Dunn said...


Yes, you're right, I agree.

Unfortunately, there isn't just one problem, never mind knowing what it is.

At the moment the government's problem is how to wring some value out of myhr, it having failed to deliver or even show how it could deliver clinical value. The value the government is trying to get out of myhr is monitoring and influencing GPs - something that does not require improved interoperability between clinical systems.

Dr Ian Colclough said...

Spot on Bernard. Unfortunately government has demonstrated it is the source of so many problems creating confusion and obstructing progress. There is only one way to fix that.