NEHTA to fund secure messaging interconnectivity

The National E-Health Transition Authority (NEHTA) will fund secure messaging vendors to work together to enable their products to connect with each other and between healthcare providers, with particular emphasis on the primary care sector.

In a statement, NEHTA announced that the Secure Message Delivery – Proof of Inter-connectivity and Deployment (SMD-POD) project “will provide financial assistance to secure messaging vendors to provide proof that standards-based secure messaging can be deployed in a scalable way”.

The project will also enable vendors to demonstrate that different conformant secure messaging products are capable of interconnecting within the Australian primary care sector and with other healthcare providers, including specialists, allied health providers and hospitals.

NEHTA will pay the vendors' costs of testing their products in a NATA-accredited lab if they successfully complete conformance tests to Standards Australia technical specifications for the Secure Message Delivery (SMD) standard, ATS 5822-2010, by January 31, 2013.

This is currently a requirement of the eHealth Practice Incentives Program (ePIP), due to come in in February next year.

Peter Young, executive general manager of DCA Health, which markets the Argus secure messaging service, said he welcomed initiatives to promote interconnectivity within the industry based on the SMD standard.

"We believe this will drive industry acceptance of secure electronic messaging as the natural means of communicating between healthcare providers," Mr Young said. "Collaboration within the industry is essential for this to occur."

To qualify, vendors must have an established Australian user base of more than 50 installations in general practices in two or more unconnected locations. They must also be capable of connecting to the Healthcare Identifiers (HI) Service to access a healthcare provider organisation’s end-point, and to be able to both send and receive referrals to and letters from specialists.

NEHTA will also provide funding of $15,000 to vendors who have completed the NATA testing and have successfully completed interconnectivity testing with at least two other conformant products. Three secure messaging vendors – DCA, HealthLink and Global Health – are currently testing their connectivity under the SMX project.

Geoffrey Sayer, head of operations for HealthLink, said SMX was well suited to deliver the objectives of the PIP program. "The three companies are naturally supportive of this process as we have already been working towards achieving these capabilities," Dr Sayer said.

"In addition, SMX will be providing greater reliability and sustainability for the benefits of our collective users. This is possible through practical day to day service and support requirements that move beyond PIP eligibility.”

Mathew Cherian, managing director of Global Health, which markets the ReferralNet system, said the addition of interconnectivity and two-way messaging as pre-requisites "is a huge positive for the sector".

"As general practitioners embrace two-way electronic messaging, vendors can focus on increasing coverage to the non-GP sector and expanding the range of documents that can be promptly and safely exchanged," Mr Cherian said. "Connectivity is such a key foundation to innovation and we believe this is the single most important enabler for eHealth momentum.”

Medical-Objects, which is not part of the SMX partnership but has a prior agreement with DCA to interoperate once standards are in place, will take part in the new SMD-POD project, its founder and managing director, Andrew McIntyre, said.

"Medical-Objects has always embraced standards and interoperability and achieved AHML HL7 certification over five years ago," Dr McIntyre said. "We welcome the opportunity to demonstrate the standards compliance of our SMD messaging solution which has been engineered from the ground up with technical excellence and open interconnectivity in mind.

"The ability to freely interconnect is an important first step in allowing the free exchange of patient data in a secure, safe manner."

The project signals a more aggressive move by NEHTA and the government to fund interoperability between vendors. It follows a recent agreement between the two electronic prescription exchanges, eRx and MediSecure, to enable their products to interoperate.

Pulse+IT understands that the Department of Health and Ageing (DoHA) brokered the ePrescribing deal, although the department did not wish to comment and there is no word as yet whether that project will also be funded.

In its statement, NEHTA said the SMD POD project was not intended to reimburse the full costs of developing and implementing conformant solutions, but to offset a portion of the costs that vendors will incur by participating in the project.

Vendors are required to respond to the invitation to participate by November 30.

Posted in Australian eHealth


0 # Keith Heale 2012-11-21 14:06
Considering that "connectathons" have been going on since April 2010 ( there seems to have been very little progress in the last two and a half years! Numerous announcements have been made of agreements to cooperate on interconnectivi ty, but the silos are still intact, and GPs are quietly going mad as they continue to generate and receive mountains of paper referrals and specialists' reports. As for electronic prescription exchanges, can someone explain how you construct a CCA procedure when there is no standard to conform to? This is not the way to create a secure bulletproof ETP system.
0 # SJ 2012-11-21 20:22
Hi Keith, I'm probably a bit more optimistic about this and think it's worth acknowledging that since NEHTA/DOHA started direct funding of software development outcomes (mostly via the GP Vendor Panel), things have progressed at a reasonably steady clip and it's now finally possible to point to deployed software that include features relevant to NEHTA's program of work.

It's certainly been a long time coming and one wonders where we'd be now if government had focused more on such activity in the early years of NEHTA's existence, and less on trying to avoid what I've always seen as both the inevitable and necessary approach to advancing eHealth in Australia.

There's never been a business case for secure messaging interoperabilit y in Australia as ultimately (at least initially) it shrinks the pie, so it shouldn't be a surprise collaboration has been a long time coming. Further, SMD (a transport mechanism) doesn't solve the more serious problems of message content standardisation and the way the sending and receiving clinical software tracks electronic messages, so in many ways SMD has always been viewed as a solution in search of a problem.

In any case, my understanding is that most of the technical challenges the SMX group are dealing with aren't far off being solved, even if it's taken longer than they may have anticipated at the outset. A bit of funding at the 11th hour in proceedings can only help one imagines.

0 # Felix Burkhard 2012-11-26 14:57
I look after the IT of several GP practices and also some allied health professionals. The local area health service has been pushing Medical objects in this area, so we now have a fair uptake and interoperabilit y by using a single messaging provider.

However, Medical Objects (MO) is currently limited to exchange data based on the HL7 standard which is purely character based. When asked why we were unable to send supporting documents and or images, MO support staff stated that they can only support the lowest common denominator...

Most GPs have not used MO because they can not easily send extra supporting information from their clinical software, such as letters from other referring specialist, pathology results etc. HL7 does not even support the use of simple tables that are often used by psychologists to report back on their findings.

we need a system where a health professional can select any of their data collected data to support a case and forward this to another health professional, rather than just having a simple referral letter submitted and sent.
0 # Keith Heale 2012-11-29 08:51
Simon says: "There's never been a business case for secure messaging interoperabilit y in Australia as ultimately (at least initially) it shrinks the pie, so it shouldn't be a surprise collaboration has been a long time coming. Further, SMD (a transport mechanism) doesn't solve the more serious problems of message content standardisation and the way the sending and receiving clinical software tracks electronic messages, so in many ways SMD has always been viewed as a solution in search of a problem. "
Anyone who can write that needs to spend a week in the office of a general practice opening envelopes and scanning every page into a pdf file. The "pie", as you put it, includes the millions of letters between GPs and specialists, hospitals etc, which are still sent by "snail mail". I accept that SMD only solves part of the problem, but can the entire medical sector afford to wait for another decade or so while the software industry contiues to argue about which way to approach content awareness? What's wrong with proceeding one step at a time? The technology was available ten or fifteen years ago to do SMD, but leadership has been utterly lacking, and as a consequence we have all paid a huge penalty. SMD is not "a solution in search of a problem" if you are an end user. Scanning paper documents costs practices across Australia hundreds of millions of dollars a year - just do the arithmetic. I used to be optimistic, but this farce has been playing out for far too long. To the news that the SMX group (three vendors out of a dozen or more) "isn't far off solving the technical challenges" (of interoperating) I can only respond with "modified rapture". Cheers, Keith
0 # SJ 2012-11-29 15:59
All good points Keith, but be aware that I've spent more than my fair share of time in front of a scanner - we retrospectively scanned our entire medical records room (about 80 doctor years worth) perhaps 8 years ago now and have been benefiting from the up front time investment ever since.

My point about the business case for interoperabilit y was from the point of view the vendors involved -- at least my outsider's view -- not healthcare organisations which clearly stand to benefit from interoperabilit y. I think we're on the same page about the multifaceted nature of the problem and I like incremental approches but I see interconnectivi ty (ie SMD) as one of the last steps, not the first as it's the easiest problem to work around in the interim -- something practices so inclined have been able to do for over a decade, hence my 'solution in search of a problem' comment.
0 # Keith Heale 2012-11-30 13:16
Simon, having done a lot of scanning of documents you will know what a mindless and error-prone task it is! I estimate that staff at our practice spend about 10 hours a week on scanning and shredding, let's say $400 pw or $20,000 per year. Multiply that by 7000 general practices and you have about $140 million pa of mostly wasted effort. And that's every year for the last 10 or more. I don't pretend that SMD would eliminate those man-hours but it might cut the number in half. We also need to take into account faster delivery of results, fewer errors in recording and filing the documents and the fact that electronic documents can be searched while scanned documents cannot (OCR is generally too inaccurate).

I realize that your "no business case" comment was made in the context of the software providers, but it's the healthcare providers who pay subscriptions for support of the messaging products, and frankly we're getting pretty poor value for money at present. I wish we had cancelled our Argus subscription until interworking was a fact.

Your last comment leaves me completely bemused - what is the "easy workaround" that practices have been able to do for over a decade and which I have so utterly failed to discern?

".. I see interconnectivi ty (ie SMD) as one of the last steps, not the first as it's the easiest problem to work around.."
No, no, a thousand times no! You do the easy things first, get some runs on the board. We could have been getting some benefit for years just with interconnectivi ty (labour savings, quicker results, searchable documents, fewer errors), and it would have provided stimulus to get the more difficult problems resolved.

Sorry if I appear unduly negative in these comments - I'm sure we agree on far more than we disagree! But there is no need to debate the stuff on which we agree so all the attention seems to focus on the differences. Also I'll be a lot more positive when there is some tangible progress - there have been announcements of agreements going back 3 or more years but absolutely no change for paying customers.
0 # SJ 2012-11-30 15:09
Yep, let's defer to a beer some time....have a few weeks onsite in our practice booked for PCEHR related upgrades so might come away more jaded than I am currently.

The workaround we've adopted is to install each and every messaging solution we can find. To an extent this has come unstuck now that GPs are being asked to contribute to the cost of messaging by some providers, and as you say, it's hard to justify buying things in duplicate with low transaction volumes. Appreciate your informed comments and interest - take care.

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