Hopes for secure messaging interoperability meet reality

Pulse+IT celebrated its 15th anniversary just a few months ago and while we don’t like to reflect too much on the damage those long years have wreaked upon our good looks, modest charms and superior intellect, it would be remiss of us not to mention some of the dashed promises and forlorn hopes that have accompanied our journey.

Our first issue was printed in August 2006, featuring a glamorous photo of a Canon camera and a rather unpleasant skin cancer to illustrate a story on digital clinical photography, along with the wise words of our first ever covergirl, then health minister the Hon Mr Tony Abbott.

Dr Tony Lembke wrote about the powers of Google, NEHTA CEO Dr Ian Reinecke expounded upon the new organisation’s virtues, and we even had one of the first columns in the world on the powerhouse that has since become podcasting.

Secure messaging wasn’t mentioned as such, but the first issue did have a column on a new intelligent messaging provider called 2Hippo. We can’t say that ever took off in healthcare, but the issue of interoperable secure messaging has been one we have covered day in, day out, at length and ad nauseam, for many long and tedious years since.

This week, the South Australian government announced it had begun the roll-out of the nationally agreed, industry-led, much-debated standards for interoperable secure messaging through the statewide system built by HealthLink that will initially be used to send out discharge summaries from public hospitals to GPs, regardless of what secure messaging vendor they use. (It will also replace SA’s ancient pathology results notification system, but more about that next week.)

The SA project has been put forward by Australian Digital Health Agency (ADHA) CEO Amanda Cattermole as proof that at least one of the seven pillars of the National Digital Health Strategy has been achieved. The plan is that it will be extended to other clinical document exchanges such as eReferrals and specialist letters.

Goodness but we hope so. We’ve been covering this topic for close on 15 years and it continues to live down to expectations in failing at every turn. Each step forwards with secure messaging seems to come with two steps back. New Zealand sorted this problem out a long time ago but Australia continues to flail about trying to solve a problem that newer technologies will probably render increasingly redundant.

Also this week, we heard from Telstra Health managing director Mary Foley on her plans for the company. Professor Foley hopes for some pretty decent revenue in four years’ time to make up for the vast sums paid for some of its assets and the losses it has accumulated trying to run them to date. The purchase of PowerHealth Solutions ($95 million) makes up a large part of the company’s future predictions, but one still wonders why she paid so much for MedicalDirector ($350m), which does not.

One of our most popular stories this week was ACT Health’s use of its new digital health record technology to care for people with mild COVID-19 symptoms at home. Despite the Australian government’s very fuzzy $180 million fund for caring for these people at home by GPs, it seems jurisdictional and regional health services are still expected to come to the party. We’ll have more on that next week.

That brings us to our poll question for this week. Last week, we asked: Should the $180m community COVID package have been spent on telehealth and remote monitoring instead? The vast majority agreed: 92 per cent said yes, just eight per cent voted no. We got an exceptionally good response in our comments.

This week, we ask:

Is interoperability between different secure messaging products worth pursuing?

Vote here or leave your comments below.


0 # Kate McDonald 2021-11-26 12:17
Is interoperabilit y between different secure messaging products worth pursuing? Most people are still keen: 85 per cent said yes, 15 per cent said no. We also asked your reasons why.

- Makes for easier patient management

- Because it's vital that systems can pass information between each other - it makes no sense for every company dealing with the same patient to type the information to each system creating problems with consistency.

- Haven't we had enough of systems that don't talk to each other?

- important

- Disparate data in health is dangerous

- Let market forces prevail.

- Supplanting technologies on the way that improve consumer experience
Too often I send a secure message, only to be phoned for a fax because the recipient didn’t have the same software, even though there was no indication of that at my end.

- Interoperabilit y as a technical issue is useless until there is consistency and standardisation at the medical content level. This is likely to be a long time coming, if ever. Without it technical interoperabilit y will just be a digital replacement for the fax - i.e. progress - zero.

- 1. Not secure
2. Point to point
3. Doesn’t support patient’s choice of service provider

- There will always be different secure messaging vendors in the market, with different functional differentiation either for specific speciality needs or for the sake of making them more attractive to the purchaser. With the inevitability of multiple end products it is essential that we have sound and resilient interoperabilit y between these secure messaging products or else the healthcare industry will never be able to truely achieve clear pathways of communication between multiple and dispersed end points. This is why is has taken so long to get to this point with secure messaging. Ensuring we maintain and progressively enhance the secure messaging protocol and standards and ensuring that interoperabilit y between different products can be part of the whole strategy, healthcare will be able to obtain seamless integration between many different vendors, public and private, whilst still enabling competition and innovation between many vendors within the healthcare IT ecosystem. This will then bring healthcare closer to a better patient oriented care space where information is shared through distributed systems, as well as large central repositories (such as MyHR) to alleviate the single points of failure.

- Let free market forces prevail. ADHA and NEHTA before it are, and have been, incapable of setting in place a strategy to bring about interoperabilit y between multiple, competing, messaging vendors; regardless of whatever goodwill exists between them to bring that to fruition. There are a number of clear and valid reasons for why that is so.

- ADHA and the bureaucracy have neither the insight, acumen of understanding, or the necessary astute strategic thinking and market development skills, to achieve interoperabilit y between messaging vendors. It is possible to achieve that 'end-result' but few individuals have the experience or skills to bring it about in the hugely complex health domain.

- Interoperabilit y was never about messaging, that has been around since 2013, but the lack of useful implementation at primary health coalface, knowledge of endpoint capability and directory services killed it. Those issues still hobble the service today, and will be only be resolved by direct communication between health service providers systems - ie not via secure messaging store and forward services.

- Make letter sending so much easier. Hence better clinical handover and outcomes

- More transparent assessment of quality of messaging products

- Because you'll never get everyone using the same system!

- SMD should be imbedded into all EMR software and securely communicate with all other providers. Simple!

- Universal adoption of secure messaging depends on this being achieved (unless we prefer to accept a monopoly by one secure messaging provider).

- Easily sharing clinical information between as many providers as possible is good for the health system and patient care

- The use of secure messaging is currently limited in scope, due to competition. Sounds odd, right? "Competition and diversity of offer is stifling scope" just sounds like it couldn't be an outcome in a free market... and yet the inability of these systems to inter-operate, combined with different fees for each potential service offer, and a broad array of individual 'subscribers' in the form of health services, general practices, allied health, and pharmacists in the community setting and independent pharmacists providing medicine review service, means that many practitioners choose not to utilise secure messaging at all instead of "choosing the wrong one". The lack of interoperabilit y between secure messaging providers is the life support system that keeps faxes and unsecured emails active in health.

- The ability of information sharing needs to be solved ASAP

- If FHIR is used properly and supported by application vendor's natively, it's secure by design and entirely Internet based. The model proposed by ADHA is poor by design and expensive, as it's a per-transaction cost. What other industry charges for secure messaging?

- the acute and primary health system is so complex and interlinked for the patient, so efficient communication between their clinicians and services will (hopefully) reduce mistakes, unnecessary repeat tests, and improve the fidelity of screening, assessments, diagnosis and referral.

- It will allow for easier communication between healthcare providers and still giving people choice which service they use.

- So that the whole sector can communicate without any issues. So that clinical staff can be clinical and not need to be technical. Remember when mobile phones could only be used to call someone on the same network?

- It's a no-brainer to have standards-based interoperabilit y.

- As it makes us more productive as a nation

- Accessibility of data for better outcomes of care

- Greatly simplifies the requirements for practices if they only need to deal with one vendor.

- It adds no obvious value, and it allows for one vendor to create a monopoly through price discounts

- Continuity of patient data across all necessary platforms supports better clinical decision making. Aligning to so few vendors doesn't allow for innovation that comes from competition so having the best products for vertical functions makes sense

- Lack of interoperabilit y is the main barrier to the digital transformation of healthcare, and needs to be applied across all digital health technologies. ADHA is currently consulting on a draft Interoperabilit y Plan that should move the dial on interoperabilit y in Australia.

- What is taking so long?

- prevents the old adage of "all your eggs in one basket". a system failure across a messaging app could cause issues for hours, days or weeks. Interoperabilit y between different platforms would allow a back up to be used while maintaining conversation history.

- PCEHR/MyHR is not the answer. There needs to be something like secure messaging. NEHTA/ADHA keeps failing to consider how to encourage the providers to interoperate.

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