This went up a day or so and it is reproduced with permission.
Clinical Messaging in Australia
Posted on March 28, 2019 by Grahame Grieve
The Australian Digital Health Agency is working hard on replacing faxing with secure messaging. Peter MacIsaac discusses one of the ancillary challenges this causes in Pulse IT today:
“The second barrier to successful cross-transfer of messages is that the messages sent by almost all health services do not comply with Australian messaging or vocabulary standards.
Likewise the major clinical system vendors are not capable of processing a standard HL7 message, if one were to be delivered to them. Senders and receivers have each interpreted the international HL7 messaging standard independently of the agreed Australian standard and associated implementation guidelines.”
I don’t think this quite expresses the problem – while there definitely are problems with non-conformance, there are also areas with the Australian standards are simply not detailed enough, and a lot of the problems are in this area.
Peter also recalls that we discussed this:
“A collaborative effort to achieve networking by messaging vendors some eight years ago was run in a process facilitated by IHE Australia, HL7 Australia and the MSIA”
Indeed we did, and we came up with a list of issues with implementations that went beyond non-compliance with the standards. I later wrote these up for MSIA, but the MSIA never published this document and pushed for conformance to it – another lost opportunity, from my point of view. Since the document was never released openly, here it is:
MSIA Clinical Messaging Profile Download (The document date is 2011)
Looking back at this – the document format rules around pdf, rtf, etc. are problematic – that’s the set of rules that we required then – and pretty much still do now – to get true clinically safe interoperability. But I don’t think many implementers in the industry can actually implement them – they depend on libraries that just don’t have that kind of control. To me, this underlines the fact that clinically safe interoperability is always going to be work in progress, since we need better standards compliance than the wider industry (so far as I know)
----- End Article.
It should be noted that this shows one aspect of the work that is needed and right now is not happening with any speed! There are a lot of other parts to also be addressed.
After all this time I wonder why this 2011 effort did not make more progress. Anyone with deep history knowledge of all this?
I look forward to some interesting comments on how far we have to go to make ‘axe the fax’ anywhere near reality – despite the ADHA propaganda.
David.
ps. Away from the article can I just comment on the 'Axe the Fax' nonsense. The fax machine will be phased out when the vast majority of actors in the health sector have access to reliable, trustworthy and secure clinical messaging. This means virtually all specialists, GPs, Hospitals Labs etc. and Allied Health. This is what determines when the axe falls and I would be surprised if it is done in under a decade. What is your call?
D.
ps. Away from the article can I just comment on the 'Axe the Fax' nonsense. The fax machine will be phased out when the vast majority of actors in the health sector have access to reliable, trustworthy and secure clinical messaging. This means virtually all specialists, GPs, Hospitals Labs etc. and Allied Health. This is what determines when the axe falls and I would be surprised if it is done in under a decade. What is your call?
D.
The ‘Fax’ has had an interesting 170-year history. It started with the ‘automatic chemical telegraph’ and although the science was exciting the fax faced competition from the ‘new telephone’ and existing telegraph which meet most people’s needs for communication.
ReplyDeleteThere was another challenge - The success of the fax necessitated a practical system of equipment, wires, and code as well as markets that could generate profits that did not yet exist.
Almost a century passed until the advent of the camera, and for an industry to realise the potential in the transmission of identical photos over large distances. (your Grandparents would remember the amazing ability to have photos of distant lands in the local newspaper and the same photo in all papers). This provided the business models and competitive market because it enabled newspapers to print images with the latest news, and that sold papers, value was obtained by all stakeholders.
Of coarse we should not forget the greatest contributors to innovation – the military and they picked up the fax to send maps and charts between aircraft.
But the power of the facsimile remained foreign to the average joe until the Japanese made use of it as an alternative to operating complex kanji typewriters (There are tens of thousands of kanji characters), so the typewriter telegraph was fine in the west for some it was loathsome). The Japanese began looking at the fax's potential to reliably send handwritten messages over great distances and by the 1980’s Japan was the leading market for fax machines.
To break out into broader adoption the creation of standards proved essential to the fax's increased use in the West.
Up until 1980, one of the big problems of fax machines is that companies were creating incompatible machines (that couldn't communicate with each other). That year the International Telecommunications Union passed a Japanese-based standard called G3 that made it possible for competing firms to standardise their communication protocols. As prices dropped, faxing settled in as a key technology of the late last century, and people took advantage of their ability to transmit anything they could put on paper.
But the internet revolution of the new millennium rocked the fax. In some ways the fax contributed to its own demise by inculcating its users with the expectations of immediately accessible images.
We now have assumptions of rapid, inexpensive, and accurate communications of documents and images by anyone worldwide. It's the democratisation of information.
So, the challenge is not the fax (which helped propel human technology into the information age). But it is our collective expectations for immediate accessible data and information. Clinical Communications is also presented with a raft of communication options. Secure Messaging is a small boat in a flotilla, it is not the fax that is the only competition. You want paperless healthcare? Remove the printer.
Clinical communications between organisations, systems and devices needs to learn from the fax journey, co-create a value system and deliver the outcomes that make the fax obsolete, not comparable, that is an alternative, why change if I do not gain additional value. Value is created by the consumer not the supplier.
Standing on a soapbox calling the fax names and branding it fake interoperability is childish and counterproductive.
Standardise and enforce those standards. Standards, legislation and policies provide the ‘informing’ and ‘constraining’ effects we need to ensure software is fit for purpose and use. Innovative firms are good at finding information in Standards, and, because they are ‘pushing the boundary’, they also find that regulations constrain their innovative activities - but do not prevent these.
@5:48PM thanks for the interesting history lesson. You raise some interesting similarities between the fax uptake and secure messaging. I totally agree the ADHA is faced with a staggering number of alternatives so they will need to come up with something oozing with utility and value.
ReplyDeleteStanding on a soapbox calling the fax names and branding it fake interoperability is childish - agree 100%, this has been a theme through this iteration of ADHA and to some extent across the digital health landscape.
The reality of allowing very low bar entry and self declaration will be that secure messaging will be ticked off as a success and perceived as such by the department of finance. Funding will be turned off and the messaging market will sink or swim. It is hard to see the ADHA not being rolled back under the Department of Health in Canberra. My advice would be for those who actually care to ensure the bar is raised very high or look for international efforts to keep you busy.
David as for faxes, they will continue to exist in some shape or form, the removal of the need to have an analogue line has ensured it will be with us for some time.
Once more unto the breach, dear friends, once more; Although we have filled the wall twice-fold with empty gestures and taxpayer funds
ReplyDeletehttps://www.pulseitmagazine.com.au/news/australian-ehealth/1032-secure-message-exchange-market-opens-up
Might be quicker to just wait for quantum health (qHealth), will most likely make current PKI obsolete. Although not all PKI it is pretty nice when implemented correctly
ReplyDeleteThe link to the Pulseit magazine article is quite depressing, especially when I saw this "Written by Kate McDonald on 07 June 2012."
ReplyDeleteThat is 7 years ago, no progress on compliance, NASH or identifiers since then... Talk about ineffectual governance, how much has been spent since that date I wonder?
Interesting how the one thing that there is a majority consensus on from GP's is an ability to securely communicate and send messaging seems to get trumped every time by the PCEHR/MYHR which has the dubious history of being rejected by the majority as a waste of time and a distraction.
ReplyDeleteI cannot work this out, secure messaging and various layers of interoperability do not pose a threat to the software and system vendors, does not pose a threat to the healthcare sector and does not increase the risk profile for consumers.
@10:45 AM It's not that difficult to work out. It's all due to bureaucratic meddling. Underfunding NDIS is a good example. Another is ('please explain if you can') VIC is deploying its RTPM Safe-Script system, ACT & NT (both Federally funded Territories) are promoting the TAS developed DORA system as the preferred RTPM system. Why?
ReplyDeleteWhy is there no uniform agreement on one standardised national RTPM solution?
Why is there no uniform agreement on one standardised national RTPM solution?
ReplyDeleteBecause government is crap at innovation.
Government can be quite innovative, what the ADOHA is doing is not in the DNA of our Government institutions. They should be setting the standards and legislation that enables good product and service innovators to excel and expel those less mortal.
ReplyDeleteIt takes a broad mix of skills working together (not against) to get the job done. My observations to date is everyone is competing to be the 'hero' and the result is MSbP outcomes.
Even the Interoperability webinar was a classic reflection of this. Everyone spoke well and new there domain but collectively it just sounded like - I'm Spartacus, no I'm Spartacus, no only I can turn this around, no listen to me …... (apart from the Boadicea contribution, would have paid to have that edited.
If you want to know how ADHA did in the budget go here:
ReplyDeletehttp://www.health.gov.au/internet/budget/publishing.nsf/Content/2019-2020_Health_PBS_sup1/$File/2019-20-Health-Portfolio-Budget-Statements-v-2.pdf
and start at page 173.
It's the usual guff that doesn't explain exactly how health care will be improved.
There also doesn't appear to be any funding after the next financial year.
The long term purpose of the ADHA is to just run myhr.
There certainly does not appear to be any innovation just more of the same old stale mantra.
Two observations re the budget papers
ReplyDelete"Program Objective - Program 1.1: Digital Health
In collaboration with consumers, healthcare providers and the health industry3, the Australian Digital Health Agency will deliver an effective national digital health capability that will achieve significant improvements in the quality and delivery of health care, and increased efficiency of the Australian health system."
I have never seen any measure of "significant improvements in the quality and delivery of health care, and increased efficiency of the Australian health system.", either in the budget papers (which might not be the place to find them, although if it were good news, that's where you are likely to find at least a mention of the raging success myhr has achieved after nearly 7 years operation) or on the ADAH website.
secondly
1.1 STRATEGIC DIRECTION STATEMENT
...
The Strategy articulates the need for a coordinated approach to the delivery of digital health within Australia, and identifies seven strategic priority outcomes:
1. Health information that is available whenever and wherever it is needed.
"Health information" is never defined, anywhere, ever.
A defining characteristic of the myhr is that it is not a clinical record (that would put it into competition with vendor products) it is a summary system with no historical data (i.e. data before it starts being used).
The whole premise of myhr is built upon a lie - a lie by omission, but nonetheless a lie.
Worth noting the Department of Health loses 6.4% of its ALS (staffing level) allocation. That is about 256 souls. That will impact all DOH agencies. From what I am interpreting from the budget commentary is much of that $200m will go to DHS to operate various services related to the safe, secure and secret harvesting of your health information.
ReplyDeleteBefore everyone gets all hot, bothered and excited about the supposed funding boost to ADHA of over $200m, you need to look at last year's budget.
ReplyDeleteThere was no funding in last year's budget for the ADHA in 2019-2020.
All that is happening is that ADHA is being funded on a year by year basis. There is no boost.
The fact that their budget has gone down is neither here nor there, they have finished going to opt-out.
If you look at the table on page 31 it shows that myhr budget measures are elsewhere (i.e. in the section of its own). Other budget measures in the table have out year (i.e future) forecasts
e.g. Other measures such as "Investing in Medical Research - Medical Research Future Fund - Ten Year Investment Plan" have future funding.
myhr doesn't.
the opt out funding was separate. they have had their core funding cut.
ReplyDeleteI didn't see any funds for re-platforming.
ReplyDeleteI also see Jim Birch is not expected to stay at ADHA.