$$ - Secure Electronic Messaging With Medial-Objects
This is the third article in a perpetual series of technical demonstrations designed to assist medical facilities to better understand secure electronic communication.
Like its predecessors, this article demonstrates a secure messaging scenario using software that is available now, namely MedTech 32, Medical Director 3 (MD3) and Medical-Objects.
The first article in this series demonstrated the transmission of an electronic referral from a general practice running Genie, to a specialist practice using Medtech Mercury. Healthlink was used to transport the message between the two practices.
The second article demonstrated the transmission of an electronic referral from a general practice running Best Practice, to a specialist practice using Zedmed. Argus was used to transport the message between the two practices.
This article consists of three sections:
- A brief description of the software and companies referenced in the article.
- An overview of the installation and configuration procedures used to prepare the software for the demonstration.
- A demonstration of one possible use of the combined software solution.
Given this broad scope, some of the technical explanations in this article are dealt with less comprehensively than others. Where further explanation is required, the vendors mentioned in this article will be happy to assist practices to adapt the information presented to their own situation.
IT TAKES THREE TO TANGO
The demonstration in this article is framed around the transfer of a discharge summary from a GP After Hours Clinic (GPAHC) to the practice of the patients usual GP.
Readers may be interested to note that the secure messaging demonstration presented in this article draws heavily from a real-world GP after hours clinic discharge summary initiative, namely the one established by the Hunter Urban Division of General Practice for their GP after hours clinic in Newcastle.
There are three software applications used in the scenario presented in this article:
- The senders clinical software.
- The recipients clinical software.
- The messaging software.
The Senders Clinical Software
For the purpose of this demonstration, MedTech32 will be the software used to generate the discharge summaries at the GPAHC.
MedTech32 is a practice software solution that integrates clinical, billing and patient management features.
Medtech32 is developed by MedTech Global, a New Zealand based company with Australian offices in Melbourne, Sydney and Perth. The companys recent acquisitions of CompuDoc and the publicly listed Australian Healthcare Technology Limited (developers of RX) have grown MedTech Globals Australian user base dramatically, the company now claiming to service the second highest number of practices in the country.
The Recipients Clinical Software
For the purpose of this demonstration, Medical Director 3 (MD3) will be used as the clinical software to receive the discharge summaries from the GPAHC.
MD3 is developed by Health Communication Network (HCN), Australias market leading provider of clinical and practice management software to GPs and specialists. Health Communication Network (HCN)s head office is located in Sydney, with satellite offices in Bundaberg, Perth and Melbourne.
The Messaging Software
Software from Medical-Objects has been chosen to transport the message between the GPAHC and the usual general practice of the patient that presented at the GPAHC.
Medical-Objects is a medical software company specialising in secure messaging and decision support solutions. The company is headquartered in Buderim, QLD.
Medical-Objects has a range of messaging and related clinical products, Medical-Objects Messenger Real Time (RT) has been chosen as the software application to transport the message. This product is also dubbed Capricorn, a name that, for the sake of simplicity, will be used throughout this article when referencing the software.
Capricorn is designed to run as a local HTTP server within the medical facilitys LAN. The software offers message sending and receiving, provider lookup and SNOMED-CT terminology query functionality. Capricorn has the ability to receive and transmit via HL7 LLP (TCP/IP), SMTP, and SOAP web services, in addition to common file drop interfaces.
The software can be installed as a background service, or as a tray icon application on Microsoft Windows 95, through to Microsoft Windows Vista. Native MacOS X & Linux versions are in the pipeline, and will supersede the current Medical-Objects Java based download client.
Following are the steps that need to be performed before a site running MedTech32 can send a secure electronic After Hours Consultation Discharge Summary (HL7 REF^I12) via Medical-Objects to a site running MD3.
Please note that while these instructions are specific to MedTech32 and Medical Director 3, practices using other clinical software should be able to apply significant parts of the information presented to their own circumstances.
Install And Configure Medical-Objects
Before the transport of the message can take place, Medical-Objects software needs to be installed at both the GPAHC and the recipient GPs clinic. The installation and configuration for both the sending and receiving site are outlined below:
- Visit the Medical-Objects website to apply for an installation token and submit your details for inclusion in the provider directory.
- Download the Capricorn installation package from the Medical-Objects website. This installer is approximately 5MB and should not take long to download using a broadband Internet connection.
- Start Capricorn and enter the issued registration token into the setup screen.
- Enter your passphrase and use the key generation tool to create encryption keys for your practice.
- Capricorn should now be running. If prompted, unblock your Microsoft Windows personal firewall to ensure that Capricorn can function properly. No incoming ports need to be opened on your LAN firewall.
- Capricorn now needs to be configured to correctly process incoming messages and acknowledgement files (ACKs) from sites that have received your practices outgoing electronic correspondence. To do this, right-click on the Capricorn tray icon and select Configure. Select Integration Options from the list on the left, then set the ACK Management fields to match the paths shown in Figure 1. All other settings can be left with their default values.
- On the left of the screen, click Server Parameters and specify the message output directory.
- A message queue now needs to be established to process the HL7 file exported by MedTech32. To do this, click Add to create the queue, then click Setup to add the required Message Decorators to the queue. Capricorn Message Decorators are designed to address a range of common syntax problems found in HL7 messages that are not compliant with the AS4700.x specifications. In the case of the exported MedTech32 HL7 file, three Capricorn Message Decorators are required to address AS4700.x non-compliance issues. The Message Decorators used in this scenario are shown in Figure 4.
- Steps 1-5 demonstrating the setup of Medical-Objects at the GPAHC need to be repeated on the MD3 server at the recipient general practice.
- Once Capricorn is installed on the MD3 practice server, the software will detect the input, output and acknowledgement (ACK) directories, which speeds up the installation and configuration process considerably.
Had the messages in this scenario been compliant with the AS4700.x specifications, the message queue would require a single entry, i.e. the Route with Capricorn script. This entry is responsible for encrypting, digitally signing and transmitting the message.
Configure MedTech32 To Send Messages
MedTech32 now needs to be configured to interface with Capricorn. To do this:
- From the Tools menu, select Message Transfer, then Message Transfer Utility.
- Click Add A New Configuration to create a new message rule and open the View Configuration window.
- Enter the details shown in Figure 6 into the fields in the window.
It should be noted that:
- The File Send Path in Figure 6 should now match the directory set in the Base Directory in Capricorn as shown in Figure 3 on page 39.
- The File Receive Path needs to match the Folder to save external ACKs for PMS field in Figure 1 on page 38.
Once these directory paths are entered, the interface between MedTech32 and Capricorn is established, allowing HL7 messages and ACKs to flow between the two software products.
MedTech32 can be configured to import and export messages on a predefined schedule. To configure the scheduler:
- From the Utility menu, select Scheduler, then Start Scheduler.
- From the Utility menu, select Configure Scheduler.
- Click the Add Task button.
- Enter Medical-Objects as the name of the task, then specify when you would like the task to run.
- Click the Browse button and navigate to the MsgTran.exe.
- Append a space, followed by a capital A to the path to the MsgTran.exe, i.e.:
This step is necessary to ensure that the Message Transfer Utility runs automatically after being opened by the scheduler.
- Click the OK button to save the configuration.
The configuration of MedTech32 to send HL7 files and process the corresponding incoming ACKs is now complete.
Configure MD3 To Receive Messages
As Capricorn has been configured to use the default Medical Director 3 message directories, it is likely that no configuration will need to be performed within the Medical Director 3 program. It is worth checking however, that Medical Director 3 is configured to export acknowledgment files on the successful import of an incoming HL7 message. To do this:
- From the Tools menu, select Options.
- Click on the Investigations tab.
- Ensure that the Generate ACK files checkbox is ticked.
- Click Save to close the Options window.
The configuration of MD3 to receive incoming HL7 files and return ACKs to the sender is now complete.
Having now presented an overview of the steps required to configure both MedTech32 and MD3 to communicate using HL7 messages via Capricorn, this section demonstrates a practical application of the technology.
Meet The Doctors
Dr Seeya Layta is a GP who works at the local Division of General Practice After Hours Clinic (GPAHC). The GPAHC runs MedTech32.
Dr Regular Practitioner is a GP who works at the Regular GP Clinic. His clinic runs MD3.
Miss Bianca Test presents at the GPAHC and is seen by Dr Seeya Layta. Bianca informs Dr Layta that she has been experiencing severe chest pain and nausea. Dr Layta examines Bianca, prescribes some medication and instructs her to make an appointment to see her regular GP later in the week.
Dr Layta writes summary consultation notes in MedTech32, and transmits a secure electronic discharge summary to Dr Regular GP.
The electronic communication interactions relating to Dr Seeya Laytas discharge summary to Dr Regular Practitioner are outlined in detail below:
1. Exporting The Letter From MedTech32
Using exactly the same steps as would be performed when creating a printed letter, the discharge summary is created. When the letter has been completed, the user clicks on the Send Via pop-up button at the bottom of the screen. Message Transfer is then selected from the list of options. A window is presented, allowing the user to specify:
- The recipient.
- The messaging software to be used to transmit the document.
- The message type.
The user then clicks OK to accept the details, then OK again to prepare and export the document, ready for electronic transmission.
The next time MedTech32s pre-defined message import/export schedule runs, MedTech32 will deposit the discharge summary as a HL7 file into the directory shown in Figure 6 on page 40.
2. Sending The Message
Almost instantaneously, Capricorn detects that a new file needs to be sent and performs the Message Decoration steps as specified in the MedTech32 message queue. After correcting any non-compliance issues, the message is both digitally signed and encrypted to ensure that the contents of the message cannot be intercepted by a third-party during transmission.
The Medical-Objects messaging system utilises clinician provider numbers to identify senders and recipients. As Capricorn uses the provider number embedded in the exported MedTech32 HL7 message, it is therefore important that the MedTech32 provider address book be accurately maintained.
In the event that the recipient has not received electronic correspondence from the GPAHC before, the Medical-Objects provider directory is interrogated by the Capricorn software and the information required to correctly transmit the HL7 file retrieved. Once the credentials of the recipient have been established, the message is sent directly to the recipients installation of Capricorn, a process that is completed within a matter of seconds.
3. Receiving The Message
At the Regular GP Clinic, the HL7 message is unencrypted and deposited into the default MD3 incoming message directory shown in Figure 5.
During this process, the HL7 envelope is modified to ensure that the discharge summary displays as intended once imported into the recipients clinical software.
4. Importing The Message Into MD3
To import the HL7 file into MD3, users simply follow the same steps used to import pathology and radiology results:
- From the Investigations menu, select Download.
- Select the appropriate doctor from the list.
- Double click on the record to review the discharge summary and action it accordingly.
5. Returning The ACK To The Sender
When the HL7 file is imported from the file system into MD3, an acknowledgement file is generated. Capricorn detects the presence of this ACK, digitally signs and encrypts it and sends it back to the GPAHCs Capricorn installation.
6. Importing The ACK Into MedTech32
When the Capricorn installation at the GPAHC receives the ACK file, it unencrypts it and deposits it into the directory specified in the File Receive Path field shown in Figure 6 on page 40.
The next time MedTech32s pre-defined message import/export schedule runs, the ACK is imported into the database and matched against the original outgoing discharge summary. The status of individual messages can be displayed visually by selecting Message Transfer from the Tools menu, followed by Messages Lodged.
This window displays the time the correspondence was created by the clinician, the time it was exported from MedTech32 as a HL7 file, the patients name, the recipients name, the message type, and most importantly, whether the correspondence has been acknowledged as having been received by the recipient.
Under Medical-Objects pricing model, the sending party bears the cost of the secure electronic communication (i.e. there are no costs involved with receiving messages).
There are several pricing options available to larger health organisations (e.g. pathology labs, radiology providers, hospitals), however specialists who send correspondence using Capricorn are charged a flat rate of $450 per year. This fee covers the software, all message charges and remote support. Specialists with more complex needs, such as diagnostic image delivery, or Specialists operating from large sites should contact Medical-Objects for further pricing information.
There is no charge levied on GPs for the use of the Medical-Objects software or the network.
While the scenario presented dealt with the transfer of a discharge summary from a GP after hours clinic to a general practice, the Medical-Objects product suite can be used to transfer a range of other clinical correspondence, including GP referrals, pathology results, radiology reports and specialist reports.
It should be noted that while Capricorn has been demonstrated alongside MedTech32 and MD3, Capricorns Message Decorators allow the software to function with many other clinical products on the market.
As has been demonstrated in this article, secure electronic communication is possible using technology currently available to general and specialist practices, and other health care facilities.
Unfortunately, there remains a wide variation in the quality of the HL7 message generation capabilities of the various clinical packages on the market. Compounding the problems that flow from this inconsistency, the message import and display functionality of clinical systems also differ significantly.
While the message decoration techniques highlighted in this article do facilitate the circumvention of these problems to a large extent, ultimately, clinicians and their patients will be best served if clinical software developers place a priority on improving the HL7 capabilities of their products with a view to having them certified by the Australian Healthcare Messaging Laboratory (AHML).
Posted in Australian eHealth