Guest editorial: the critical importance of messaging quality

This article first appeared in the August 2012 edition of Pulse+IT Magazine.

Having recently discovered deficiencies in some implementations of clinical messaging in electronic medical record systems, an initiative to improve the quality of such functionality – particularly HL7 message acknowledgements – is being launched by HealthLink.

There is a great deal of focus on the personally controlled electronic health record (PCEHR) and the implementation of related services at the moment, but we should not forget that a very large amount of patient information is exchanged across the Australian and New Zealand health sectors as an integral part of day-to-day healthcare delivery.

For the past 10 years, HealthLink has been advocating for improvements to the quality of electronic messages generated by Australian practice management systems. Three years ago, our campaign to encourage the creation of HL7-conformant messages and message acknowledgements had a major effect on the quality of electronic communications, with many Australian electronic medical record (EMR) vendors taking steps to improve their systems.

However, the time has come to make further progress on this critical problem.

To be truly useful, electronic messaging must be at least as reliable as paper-based information exchange – or preferably even more so. In health sectors all around the world, an increasing reliance on electronic messaging to replace paper-based processes has meant that it is becoming more urgent than ever to ensure that every electronic message is received by the intended recipient in exactly the manner and format intended.

Given the nature of electronic messaging, transference of information across multiple systems and the involvement of literally dozens of EMR system vendors, achieving this very precise and measured outcome requires a very disciplined and well-managed process.

So what has prompted our organisation to raise the issue of messaging quality again? Over the past few months a small number of incidents have come to light which can best be described as patient misadventure near-misses.

Examination of these has highlighted the importance of ensuring consistent implementation of messaging standards, in particular the correct and reliable use of HL7 message acknowledgements. HL7 message acknowledgements are automated response messages that tell the sending system that its outgoing message has been received by the recipient’s system and correctly imported into its database.

Recently, some problems have emerged. Specialists sending information to their referring general practices have found that lack of standards conformance among some of the EMR systems is reducing the reliability of the process.

In the worst cases, after successfully arriving at the destination site, messages are failing to be imported and the recipient systems are failing to notify the senders that this has happened. Each of these problems can be traced to one or more deficiencies in the way in which one or more EMR vendors have implemented electronic messaging capabilities within their products.

Our organisation believes part of its role is to assist in ensuring Australian EMR vendors conform with Australian messaging standards and to ensure that their systems are interoperable so that consistently dependable and accurate clinical communications is able to take place across all of the computer systems used within the health sector.

Achieving interoperability requires a collaborative approach with participants from each EMR company and providers of secure messaging services all working together to test and update systems so that they will work seamlessly, safely and reliably out in the field.

HealthLink takes that responsibility very seriously – our first major public initiative to spur improved messaging quality commenced in late 2009, when we contributed an article to Pulse+IT [November 2009, Issue 15, page 34] lamenting the poor adherence to HL7 standards within the Australian health sector.

Publication of this information created a great deal of interest in the topic. Highlighting the problems was a most effective way of helping medical practices gain a better understanding of the vendors’ capabilities; it also prompted a great deal of activity amongst medical records vendors as they worked together to lift the quality of their messaging interfaces.

Since this time, a number of EMR system vendors have made significant strides in implementing message acknowledgements and message tracking capabilities within their systems. However, some EMR systems have not made sufficient progress in this area and a number of new systems have arrived on the scene. In order to encourage continued progress in this important area, we are commencing a new education and engagement campaign to highlight the progress made and to draw attention to any remaining deficiencies.

As part of this campaign, HealthLink is contacting approximately 50 EMR software companies to ascertain the exact status of their systems’ messaging capabilities with a particular emphasis on the system functionality that ensures electronic messaging can be safely undertaken by healthcare organisations using their products.

The findings of this research will be published in a future edition of Pulse+IT and it is our intention to present the status of the messaging capabilities of all known EMR systems that have a presence in the Australian marketplace.

Additionally we are undertaking to ensure that EMR vendors are given all the help they need to understand where any potential problems and risks lie with their clinical messaging.

Approximately 12,000 healthcare organisations throughout Australasia exchange more than 100 million items of clinical information via their electronic medical record systems every year.

If even one of those electronic messages fails to import, is deficient, incorrect or incomplete, it could mean life or death for a patient. So it is absolutely essential that as a healthcare IT community we take every possible step to ensure that electronic communication is working perfectly.

We hope that the Australian healthcare IT community will work closely with us, just as it did in 2009, to bring each system up to the required level to guarantee quality information exchange and therefore certainty for patients and their carers.

Author Details

Kyle Macdonald B.Eng.(Hons), MBA
Manager of Vendor Integration, HealthLink Ltd
This email address is being protected from spambots. You need JavaScript enabled to view it.

Kyle Macdonald and his team carry out the end to end interoperability integration testing for a large number of information systems used by Australia’s hospitals, laboratories, general practices and allied healthcare providers. He has over twenty years’ experience in the health IT industry.

Posted in Australian eHealth

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