SA Health pulls out of NEHTA secure messaging trial

The South Australian Department of Health and Ageing has pulled out of a project trialling point-to-point (P2P) secure messaging between hospitals and GPs, citing a lack of critical technology promised by the National E-Health Transition Authority (NEHTA).

The NEHTA trial, which Pulse+IT understands was established to help states overcome the long-festering problem of hospitals sending discharge summaries to GPs by fax or post – or in many cases not at all – has been kept quiet, with no official announcement it was taking place.

Pulse+IT understands the trial has been testing the use of the Healthcare Identifiers and PCEHR Service (HIPS) technology – which was developed by SA Health in association with a private vendor and is now used by a number of states to link to the PCEHR system in advance of full integration with their EMRs – to also allow hospitals to send discharge summaries to GPs.

However, SA Health yesterday confirmed a tip from a Pulse+IT source that it has dropped out of the P2P trial, saying it could not make NEHTA's deadline of June 30 without certain crucial technology.

“In July 2013, SA Health engaged with [NEHTA] for a limited pilot program to test point-to-point messaging between hospitals and GPs in the APY Lands,” an SA Health spokesperson said, referring to the Anangu Pitjantjatjara Yankunytjatjara-owned lands in central Australia.

“Critical technology has not been provided by NEHTA in time to allow SA Health to test, implement and complete the pilot program by the required date of 30 June 2015.

“NEHTA was unable to accommodate SA Health’s request to delay the program beyond 30 June 2015 and as a result SA Health has withdrawn its participation from the pilot program.”

A spokesperson for NEHTA said the project involved the development of a national end-point location service by Health Direct Australia, which operates the National Health Services Directory.

“Health Direct Australia is developing a key piece of national infrastructure called NEPS (National ELS Proxy Service) that is a window into the NHSD (National Health Services Directory) and provides all of the technical interaction details required to securely address and deliver clinical messages via [the secure message delivery standard or SMD],” the NEHTA spokesperson said.

“The solution is designed to work with the existing secure messaging vendors' SMD products, as they currently provide the GP end points. Therefore each jurisdiction using this solution will still need arrangements with these secure messaging vendors but will benefit from using a national addressing solution that currently does not exist.

“SA Health has deferred participation in the test phase of the project while they determine what their state wide secure messaging strategy should be.”

Pulse+IT's source said SA Health's project team, which developed the HIPS technology, was only informed in February by SA Health itself that testing was due to start last October.

“Despite developing necessary infrastructure (HIPS), successful preliminary testing and funding available for implementation, SA Health has withdrawn from the project citing an inability to adequately test products by June 30 2015,” the source said.

The source said Queensland Health was going ahead with implementation of the P2P functionality, which NEHTA has confirmed. “[Queensland] Health is testing the sending of discharge summaries from Queensland Health hospitals to GPs using this infrastructure,” the NEHTA spokesperson said.

GPs have long complained that they continue to receive communications from public hospitals only by fax or post despite secure messaging technology being widely used for receiving pathology and radiology results from private practices.

There is still limited communication between hospitals and GPs in most states using secure messaging vendors such as HealthLink, Argus, Medical-Objects and Global Health, despite those companies working on developing interoperability between their systems.

The jurisdictions have begun to investigate how best to overcome this problem, including the use of HIPS as middleware or a broker between systems.

NSW, for example, is using its HealtheNet platform to allow discharge summaries to be sent to GPs no matter what secure messaging service they use, although this is still new and in relatively limited use.

However, GPs in South Australia have long complained that while SA Health has promised to institute a system for discharge summaries, it has not yet done so.

The SA Health spokesperson said that “until such time that a national secure communication avenue is established, SA Health considers fax or post the most secure way to send discharge summaries from its IT systems.”

This article has been updated with comments from NEHTA.

Posted in Australian eHealth


0 # Oliver Frank 2015-05-13 10:23
So what we have here is a computerised huge public hospital system communicating with computerised GPs by sending them pieces of paper.
0 # Peter MacIsaac 2015-05-13 11:25
It is odd that the private sector e.g. lab and radiology use a myriad of methods to effectively communicate electronically with GPs - the issue is that the national technology vision proposed by NEHTA does not seem to be ready and still at best in pilot phase - perhaps what is needed is a more pragmatic approach to use the technology that exists today and would be cheaper to implement that post and fax, and move in time to the national service vision, that can replace the initial private communication support vendors.

Of course the PCEHR infrastructure could allow for point to point communication if those features that are in the IHE XDS standards profile could be implemented. That way we would start to put more value in the PCEHR, and avoid the need to separate communication pipelines which duplicate infrastructure and add complexity for all. If we used one set of standards for all communication that would remove a number of barriers, but would mean a "course correction" on the part of national decision makers and funders.

A unified vision for communication rather than a patchwork approach - maybe we should give it a try?
0 # Anne 2015-05-14 11:48
SA lack of comprehension of APY realities is up there with running a hospital without patients. It works perfectly for the service provider. It is no help to patients as no service is delivered.
1. Hardware:
a) APY mail delays are legendary. The mail could go into any of multiple private mail bags for postcode 0872. If the letter gets through at all. It can take 2 months or more if it does
b) The APY internet hardware (fibre-optic) is both quicker and more reliable than either mail services, or electricity services, or suppy truck delivery of non-essential items like printer paper.
c) When there is power failure, it can last for days. SA priorities include equipping some stores and police stations with backup generators- but not medial clinics. When the power fails temperature sensitive medicines have to go to somewhere that has a generator. Like a police station.
2. Email
The sender can use SA's Outlook email system to request a receipt and, in any event, will be told if the email "bounces."
3. Fax
The receiving clinic will never know, and the sender will never know, if the fax is:
a) successfully sent to a misdialled number
b) sent to a machine that is old and has to be rebooted, killing its print memory, before the "received" message is printed.
c). sent to a machine cheerfully printing on thin air because there is no paper as
- resupply order not received
- resupply not loaded on the supply truck
- paper not loaded in the machine as all medical people in the clinic had to man the ambulance and go to a bad road accident.
4. Cultural:
Privacy issues are not the same. Individuals see themselves not as isolated beings but as one small part of a much greater whole. Most APY patients prefer not to be alone in a room with a medial professional but to be seen with others around them in the waiting room, so everyone knows what is going o and they have someone to ask when they forget what they are told. Just as happens in outpatient clinics in some Asian hospitals in national capitals.
Message for SAHealth, sent in a way equally reliable to the ways they use to communicate hospital patient information to APY doctors & nurses;
1. I work in a case based non-,medial profession &have to communicate communicate less critical information to APY doctors and nurses.
2.When I email the information to the clinic's administrative officer in Alice Springs, the doctor has the information before he sees the patient when he is next at the patient's home clinic.
This works for more people than the patient.
1. It saves my professional indemnity insurers money.
2. It saves me wasting time in a witness box at a Coronial Inquiry.

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