Pulse+IT Blog

Setting the standard for messaging

Brisbane turned on a late autumn stunner for an HL7 Australia meeting that Pulse+IT attended in the Queensland capital this week to hear all about the localised pathology and referral messaging standard that has been published by HL7 Australia. The turnout was pretty good too considering the esoteric nature of the meeting, which covered all things HL7 v2, along with FHIR, PITUS, NCTS, NCSR, NPAAC and other acronym allsorts.

The expert crowd smiled knowingly when mention was made of previous attempts at developing standards that would miraculously bring interoperability to secure messaging over the years. Jared Davison, the chief technology officer of secure messaging vendor Medical-Objects, began his presentation with a slide from back in 2007 that could easily be used today, and pathology informatics expert Michael Legg went even further back when he mentioned there'd been a mention of standards in Hammurabi's code back in 1754 BCE.

NZ goes back to basics

It was always on the cards but New Zealand has confirmed that it will not follow the lead of certain other countries we might mention and purchase or build a single electronic health record for its citizens.

Some may argue that it actually makes sense for such a small but relatively widespread population to have a single record, but even back in 2015 when the idea was first floated, there was a recognition that there were perhaps easier, less expensive ways of digitising the health system using existing technologies.

It looks likely that New Zealand will instead pull together its four regional systems and underpin them with a national health information platform (nHIP)). This makes a lot of sense, as in two of those regions there is already what amounts to a functioning shared record for most people.

It is perhaps the South Island experience that has shown why a new, single EHR is not necessarily the way to go. While it has taken time, the South Island has managed to use existing technologies such as its acute care clinical workstation and GP and pharmacy systems to open a window to data held in other systems. Through HealthOne and Health Connect South, hospital clinicians can see a patient's primary care data while GPs can see not just hospital data but community pharmacy and some community nursing data too.

The greater Wellington or Central region has a similar set-up through its shared care record, although it uses patient portals rather than an extract to share GP data. The Midland region is working on its eSPACE program, and the Northern region, covering Auckland, has decided against going with a single EMR covering primary and secondary care and looks likely instead to follow the rest of the country. Auckland's public hospitals are still on paper, so it still has quite a way to go.

A lot of this has come about because in primary care in particular, New Zealand has certain advantages that it has cleverly harnessed. A single national health identifier is one, an openness to using patient portals is another, as is the decision some years ago to set up the GP2GP system so patient medical records can be transferred electronically as patients move practices. For most of the last two decades there has also been one major GP software supplier and one secure messaging provider.

This doesn't make the system perfect and patients still don't have access to much of their data digitally. And as RNZCGP medical director Richard Medlicott told the Emerging Tech in Health conference this week, primary care data is still very much produced and used on a PHO basis, rather than nationally. He is also somewhat surprised to see how slow the uptake of the New Zealand ePrescription Service has been, and he is rather disappointed that the hoped for National Primary Care Data Service may take a bit longer to get up and running than first expected.

As is often the case, it is the price that appears to be holding this initiative back, but if it actually does cost just $10 million over five years, that amounts to an absolute pittance. Australia would spend more than that on workshopping the idea.

So despite the chaos that NZ's Ministry of Health has seen over the last five years or so, with several rounds of restructuring, the disbanding of the National Health IT Board and what appears to be significant underfunding of the health system since about 2009, New Zealand does seem to be getting on with it.

In Australia, we are getting on with it too but we are still grappling with some serious interoperability challenges. Next week in Brisbane, HL7 Australia is holding a workshop to tackle some of these technical dilemmas through the localisation of HL7 standards covering pathology, diagnostic imaging and referrals. Pulse+IT will be attending and we'll bring you all the news over the next few weeks.

Meanwhile, despite the outcome of Australia's federal election showing that you should never trust public opinion polling or market research ever again, we've made the decision to keep running our thoroughly unscientific and yet quite interesting polls anyway. Last week we asked: Will there be major changes in digital health policy this year? Our readers said a big no to that, even before the election result was known. 82 per cent said no while 18 per cent said yes.

This week, our poll question is: Do you think NZ's decision not to pursue a single EHR is the right one?

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

Happy democracy sausage day

Half of Australia will probably be at their polling stations chomping on a democracy sausage and voting early and often when this missive lands in your inbox, but amid all the excitement and the scent of a sausage sizzle, there's still time for our round-up of the week that was in digital health.

Earlier in the week, we had a chat with emergency department specialist Naren Gunja, who also happens to the chief medical information officer for the Western Sydney Local Health District, home to Westmead, Blacktown, Mt Druitt, Auburn and Cumberland hospitals.

MyHR: now for something completely different

Most of Pulse+IT's readers don't need to be reminded that the My Health Record has come in for some pretty harsh criticism over the last seven years, quite a bit of it emanating from us. In that time there has been a lot to criticise but it's also fair to say there are loads of true believers out there who have held firm, hoping even in the chilliest times that the system would heat up and get some things sorted.

Over those seven years there has been the odd good news story about the system in action rather than theory, some coming from actual users rather than spruikers. Patient advocate Harry Iles-Mann makes a compelling case for using the system, and there are several reports of clinicians finding something useful on the various medicines documents, for example. The Australian Journal of Pharmacy had a little story on how the MyHR proved worthy during the Townsville floods earlier this year. We'd argue that after seven years you'd bloody well hope so but nonetheless, there are good news stories filtering through.

Return of the JeHDI

The Royal Australasian College of Physicians was in the news this week with the release of its pre-election statement outlining what it thought should be on the policy agenda for the incoming government. There were some quite excellent suggestions in the document about preventative health and financial levers for improving chronic disease management and the obesity crisis, as well as a few long shots that have no chance of getting up.

Ideas like a tax on sugary drinks and volumetric taxation for alcohol are extremely unpalatable to the two major parties and would incite enormous rounds of pearl clutching from the anti-nanny state types, the very people who were responsible for encouraging the abolition of the Australian National Preventative Health Agency in 2014, which the RACP now wants re-established.

A marriage of two minds

This week's big, although not unexpected, news was the announcement that HISA and ACHI were thinking of getting together for a bit of formal cooperation. The move has been rumoured for some years, and it makes a lot of sense. For such a small industry there are quite a few different professional organisations if you include HIMAA and wider groups like AIIA as well.

ACHI has always considered itself the peak as an academic college but it has suffered in the past from a lack of administrative support, relying as it does almost entirely on volunteers. HISA on the other hand has an extremely good organisational structure and has proved itself adept at managing the various conferences and local networking events it runs.

Microsoft schedules HealthVault's funeral

It didn't come as much of a surprise so soon after the news broke that Microsoft was dropping support for its Microsoft Band and Microsoft Health Dashboard apps that it was also canning its HealthVault personal health record. While HealthVault was a pretty good product, it really never got the uptake outside of the worried well and corporate wellness markets that it needed to survive.

There are still plenty of PHRs and similar sorts of apps on the market and Microsoft itself is recommending customers have a look around for alternatives. One is Get Real Health, which is offering to let HealthVault users migrate their data over to its Lydia platform and keep the same credentials. For those who have long memories, when Google pulled the plug on its Google Health product it told users to shop around, with one recommendation being HealthVault.

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