Forget MyHR: SMD is back

As the hoo-ha over My Health Record dies down, this week the industry turned its attention back to a problem that has dogged the Australian healthcare system for well over a decade: secure messaging interoperability, or lack thereof, and the continued reliance on paper for clinical communication between different settings.

New Zealand is well on the way to solving this problem because it primarily uses one messaging service but also because its Health Information Standards Organisation (HISO) has managed to get consensus within the industry on standards for messaging along with code sets, security and privacy. New Zealand also has the benefit of a mature National Health Index (NHI) patient identifier and its associated health practitioner index.

In Australia, however, it's a different story. Pulse+IT has been a little bit guilty of overhyping several of the various “breakthroughs” in secure messaging going on for seven years now, all the way back to the SMX initiative between three of the main vendors, NEHTA's SMD-POD initiative and more recently ADHA's attempts to get interoperability going again.

Last year, there was an actual breakthrough, but news of what has happened since has been sparse as all attention turned to the My Health Record opt-out. We are not alone in having argued numerous times that had the government of the day concentrated on getting secure messaging sorted before launching into a national health record, things might have gone a little more smoothly.

This week, we learned that money will be available to software vendors, including the forgotten children in allied health and aged care, to prepare their products to handle a federated system of secure messaging. We hope to have more on this in the near future. We also learned that Queensland is set to go live next month with its new Smart Referrals system for GP referrals into public hospital and health services, using technology from BPAC Informatics.

The Queensland government is funding this system as part of a large program to reduce specialist outpatients waiting lists. Whether the program actual does reduce waiting lists is yet to be seen but the technology investment is impressive and will hopefully make a big difference to long-suffering GPs in particular.

Queensland has been a bit of a quiet achiever with this program, having opened up access to the state's Cerner electronic medical record to GPs in 2017. Queensland also announced just this month that its HealthPathways program had achieved its one millionth page view since it was first set up in 2016. There is a bit of cynicism out there about HealthPathways and whether they are being used by GPs at the point of care as they are not embedded in clinical software, but it seems to be working in the sunshine state. There is a direct link to HealthPathways in the Smart Referrals interface, so it will be interesting to see if anyone is tracking use.

However, it is also true that Queensland Health has pursued these initiatives in parallel to the national infrastructure rather than in alignment with it. Smart Referrals will not be sent to the My Health Record in the short term and while we hear this is something the project team is aiming for, it is not seen as a priority as yet.

Still, things are looking up. RACGP president Harry Nespolon was at an interoperability consultation event hosted by ADHA in Sydney this week where, speaking off the cuff, he said he believed that interoperability was the most important thing that will face general practice in the next three to four years.

“I can't wait for you guys to get this right,” he said, channeling every GP in the country. “It will make an enormous difference to practices in terms of the way they are run ... but more importantly it will give doctors more time to talk to patients.” Amen to that.

That brings us to our poll question for this week: will secure messaging interoperability be a reality in practice this year?

Sign up to our weekend edition or Pulse+IT Chat to vote, or leave your thoughts below.

Our poll last week asked: do you have confidence in ADHA's management of MyHR? Nope. 22 per cent said they did but 78 per cent were firmly in the negative.


0 # Paul Cooper 2019-03-23 10:43
Secure messaging was always intended to be a key building block of eHealth for Australia but much of the careful planning and pilotting work needed to be delayed or set aside in the haste to focus full support for the government of the day in their rush to implement the PCEHR by an artificial date driven by an election. So yes - it's great to finally see it coming to fruition. In my personal view it's a text book case of why arbitrary dates should not drive large, complex infrastructure agendas. (My views are my own and I do not represent the former NEHTA or anyone else on my commentary here).

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