How to: Ensure your electronic message has been received

How important is it to know if your electronic correspondence has been received by the intended recipient? Is it not your responsibility to ensure that your confidential patient report has been received by the intended provider in the chain of care?

In the not so “old days” of postage and fax, it was very difficult to confirm that confidential patient reports had been received, but thankfully in these days of electronic communication and with the foresight of HL7, it is easy to look at a screen or run a report to determine if your correspondence has been received.

The process is dependent on the destination’s Electronic Messaging Record (EMR) generating an HL7 application acknowledgement. When a message is received and imported by the recipient EMR system, the HL7 process requires the recipient EMR system to generate an application acknowledgement and return it to the sender. The sending EMR application, e.g. COMRAD, Medical Director 3, Genie, then uses the information in the application acknowledgment to match it to the original sent report. The original letter can be confirmed in the sending EMR application ‘displayed as received’, or more importantly it becomes easy to identify acknowledgements not received.

Is an acknowledgement the final answer or not?

It doesn’t help that there is major confusion in the marketplace about what is and what is not an 'application acknowledgment'. Sometimes the term application acknowledgment is used when the acknowledgement is generated by an intermediary application, typically one involved in the transportation of the message.

In layman’s terms this is a 'delivery acknowledgement', where the message has arrived at the destination computer, but not necessarily into the destination EMR application. There is a significant difference.

The intermediary application has no control or knowledge of the actual capabilities of the EMR application. It can make an educated guess based on good assumptions, but it falls short of guaranteeing that the recipient EMR is successfully importing each individual message.

Environmental issues include known problems that prevent that delivered message from successfully being imported into the destination EMR’s database. However, the confusion remains in the marketplace when some organisations confirm that they do send or receive acknowledgements, but do not clarify whether or not the acknowledgement is generated by the recipient EMR system, i.e. the system that consumes the message. For HL7 messages, HealthLink insists on application acknowledgments from all of its EMR partners.

Why doesn’t every message get there?

Electronic communication is currently a very exact science, but the detail is not 100 per cent understood by all of the organisations involved. The messaging organisations themselves, being experts in this area, are very robust. After all, it’s their daily bread.

Other parties, who rely on messaging “just working”, sometimes don’t appreciate, don’t understand the detail or simply don’t accept their responsibilities for ensuring the robust end-to-end delivery of clinical information.

You can equate the recipients’ responsibilities as making sure there is paper and ink in the original fax machines or requiring that the envelope is opened to read the letter inside.

Typical examples of breakdowns in the process are:

  • Practice procedure: for example, Mary is on holiday and her computer (the communications server) is switched off. The practice forgets to sign in when using manual login settings.
  • EMR network environments: Bill takes over Mary’s job, and is not given the correct computer access rights to run the communication software correctly.
  • Environmental changes: the server is upgraded, but the messaging software is not replaced correctly.
  • Required data is not recorded in the EMR, and therefore messages don’t contain valid and meaningful information.

The conundrum

The essential question is, therefore: do you regularly check your ‘sent message’ screen? Unfortunately, we know that many practices don’t check their messages have been sent, thereby ignoring this vital part of the electronic communications process. The result can be nothing short of disastrous with patient care suffering delays, or worse, finding that information has been lost in transit.

Our own statistics show that in a typical month for referrals, summaries and discharges:

  • 85.54 per cent return a positive acknowledgments
  • 0.27 per cent return a negative acknowledgment
  • 14.19 per cent are not acknowledged at all

This does not mean that 14.19 per cent of reports do not get imported by the recipient EMR system, but it does mean that there is ambiguity as to whether or not these reports have been received by the intended recipient.

What can healthcare providers do?

  1. Check the ‘messages sent’ screen and follow up on reports not correctly acknowledged.
  2. Check the ‘messages sent’ screen and follow up on reports not correctly acknowledged.
  3. Check the ‘messages sent’ screen and follow up on reports not correctly acknowledged.

If you need help understanding why you are not getting acknowledgements then please call your messaging system provider’s helpdesk.

Where to find application acknowledgements in common EMR systems

This table shows the menu paths users can navigate to review the status of application level acknowledgements
Clinical Software / EMRLocation in software
Best PracticeNot available within the software but HealthLink HUO website can be used as an alternative.
COMRADTools > Remote Queue Viewer
GenieOpen > Correspondence Log
Houston VIPPatient > Outgoing Communication > Communication type > Outgoing
IncisiveUtilities > RSD Messages > All Messages sent or Unacknowledged Messages sent
Medical Director 3Tools > MDExchange > sent items
MedTechTools > Message Transfer > Messages Lodged
PATHBaseDaily report
PractixAdministration > System Processes > HL7 Messages Log Viewer > Outgoing Messages > Enter
Software for SpecialistsAudit and Search > General
ZedmedResults > Outbox Viewer

About the author

Kyle Macdonald B.Eng.(Hons), MBA
Manager of vendor integration, HealthLink
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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