Interview: Medical-Objects

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PULSE IT: What is a practice required to do to get up and running with Medical-Objects?

All that we require is a signed application form with Provider Number and address details to be faxed to us. Installation takes about 10 minutes to complete if there are no firewall issues to resolve.

A HESA Location Certificate is not required, although should be loaded if available as it increases the flexibility of the clients.

With Specialist installs we need to understand the needs of the practice and plan the install a little more but each client install takes about 5-10 minutes.

PULSE IT: Can Medical-Objects be installed by a practice member, or is professional IT help required?

A practice member with basic skills and a login that allows administrator privileges is all that is required usually. If there are firewall issues to be resolved then IT support can be useful.

PULSE IT: What is the cost to a medical practice?

Anyone can install a client to receive messages for no cost. A client to send PKI signed referrals and GP to GP record transfers is also free. A basic specialist install with a Word Plugin is $450 a year including installation and telephone support. Additional workstation installs are $50 each. A more advanced Client with the ability to send images and create quick notes to GPs etc is $750 a year. Small pathology and radiology practices pay $1500 per copy annually.

PULSE IT: How does Medical-Objects integrate with the practice’s clinical package, and which packages are supported?

Given the lack of standard integration points we generally integrate via the work plugin and can access demographic data for many standard packages. A number of lower level integrations are currently underway (using COM+ objects/SOAP and custom import routines).

PULSE IT: How is support for Medical-Objects supplied?

Telephone support is available 6am-5pm Monday-Friday EST.

PULSE IT: In which geographical areas has Medical-Objects flourished?

We have 95% of Sunshine coast GPs online as this is where we started and continue to trial new software here. We have a large proportion of Geelong and Northern Rivers areas of NSW online and have all practices in the eastern Goldfields area online. Most of the Bayside and Redcliffe areas of Brisbane are online and we are slowly installing throughout Brisbane and the Gold Coast. There are scattered installs elsewhere, including PNG.

PULSE IT: What technical aspects of the Medical-Objects offering differentiates it from other solutions on the market?

Medical-Objects has been designed from the ground up to be a Electronic Health Record Solution rather than a “messaging solution”. Delivering results to end users is a trivial role for the HL7 Framework behind Medical-Objects and whenever we strike problems in integrating with a particular package we have the ability to massage the data in real time to overcome the issue. Whenever possible we use real-time messaging for delivery and there is no central server or single point of failure in the system. We work hard to comply with standards and are the only organisation in Australia with AHML compliance for our messages. Our applications are native, and generally single exe solutions and with the exception of our J-Client do not require Java installed.

While HTTP is our preferred transport we can and do support Argus compatible Email, PGP and GNUPG Email and have a proved SOAP interface. Recently we added AS2 (RFC 4130) to our list of supported transports. Our latest generation of GP clients use a proxy interface which allows real-time point to point delivery to GP systems sitting behind firewalls. All protocols are open and specifications are publicly available. In fact the network is open now to PKI encrypted/Signed result transfer.

As part of the Medical-Object solution we provide a HL7 based Provider Directory which relieves specialists from manually configuring every new GP and allows the discovery of remote Providers when you see patients who are on holidays away from home.

We are the only organisation with PKI signatures which allow paperless referrals. All other systems without this require that referrals be hand signed and the paper forwarded. In addition we support the dynamic conversion of reports to PIT, Text or Images, HTML or even a TWAIN emulator to allow scanning of HL7 data. We can modify the data at the endpoint to suit the needs of a particular PMS. This allows us to send images in HL7 and extract them as image files at the destination.

With Medical-Objects you have a messaging system designed for the world of real-time Electronic Health Records, rather than a system adapted to do the job now, but with no long term future. We use open standards and uniquely have proven compliance with standards. We are the only messaging provider that provides complete interoperability with another systems (Argus at this time) Currently a specialist with Medical-Objects can communicate with both Medical-Objects and Argus connected GPs.

PULSE IT: What solutions does Medical-Objects offer Mac and Linux users?

We have our J-Client that runs on OSX, Linux, Solaris and Windows. It is a client that can receive results. Specialist with OSX can use Virtual PC to send out results. We are investigating a Native sending client for OSX and Linux.

We have also run our real-time Download Client and Medical-Objects Explorer successfully working on Intel based Macs and Linux using the CodeWeavers CrossOver tools.

PULSE IT: What role did Medical-Objects play in the Health Informatics Conference Interoperability Demonstrations in August?

Medical-Objects had software installed with every vendor in the demo and did all of the transport and interface engine work for the demo. We also played the role of several Hospital Specialists, a cancer registry, and provided provider lookup services for the demo. We also did all of the HL7 display for IBM using a HL7 to HTML SOAP service we have. The demo was very ambitious and with only one setup day prior to the event the first day of the demo was very busy for us and many of the interactions were not working fully, mostly because of minor incompatibilities in the HL7 between the vendors. As we have seen in the real world simply connecting people is not enough, you need to be able to massage the HL7 a little to make things work smoothly. On the first day we had to identify the issues and configure our clients to make the necessary changes to the messages as they flowed through to recipients. Once this had been done the demo worked pretty well.

Not all vendors had AHML compliant 2.3.1 HL7 messages, and some were running older versions of HL7. To get 10 vendors talking to each other in 2 days is actually an example of how solid HL7 V2 actually is, as the level of complexity of the data was quite high. We used our new real-time SOAP/HTTP clients for the demo and it was a big workout for them. We also implemented AS2 (RFC 4130 MIME-Based Secure Peer-to-Peer) to talk to the SUN identity service and that worked flawlessly.

Communication between the players was all encrypted and all real time, using a combination of HTTP, AS2, SOAP and HL7 Lower Level protocol. You really need a have a Swiss army knife client to make things happen in the real world, and the demo was really quite similar to the real world.

For the GP nodes in the demo we provided our Referral client that uses PKI individual tokens to digitally sign the messages with a HESA Signature, making them acceptable to Medicare Australia as paperless referrals.

On the specialist side we demonstrated archetype based orders, with automatic transfer of cancer diagnoses to the cancer registry. We also used the Word Plug-in to generate reports which were then sent to other parties in AHML compliant HL7.

Overall it was positive evidence that interoperability is possible now.

PULSE IT: Aside from secure messaging products, what other solutions does Medical-Objects offer?

We started out looking to build HL7 reporting tools, and realised that a component based software framework was the only sensible way to go to enable reuse of code to occur. This was a much bigger job that initially thought, its probably taken 5 years to mature, but now allows us to rapidly build any application that requires HL7 processing, communication or display.

Our delivery is really a small part of what we do and mirrors what happens in the rest of the applications except we save the results as files rather than display it.

On the Sunshine Coast about half the specialists use Medical-Objects and many allied health providers are now using it as well. We are also handling all the clinical data for the Outpatients at our local hospital as we can bring together all the data sources and present it as a homogenous HL7 based interface. We have successfully integrated with the discharge summary system at the local public hospital without installing a single piece of software on their system.

We also understand SNOMED-CT well and have a SMOMED-CT server available now. We have DICOM and picture archiving abilities and this is used by radiologists and as we grew out of a Day surgery this is in use by ourselves and many other specialists.

We were the first, and are still the only HL7 system that has been certified as being compliant with the Australian standards by the Australian Healthcare Messaging Laboratory (AHML).

More recently we have been extending the framework to incorporate advanced clinical decision support tools and have implemented Archetype support, and a Gello compiler (The first Gello compiler in the world) and with this have been doing a project to provide high level decision support for lymphoma treatment in conjunction with Haematology Society of Australia and New Zealand , the Leukaemia Foundation, Sullivan Nicolaides Pathology, and Queensland Medical Laboratories.

Pulse IT invites organisations and individuals interested in participating in a future interview to contact the editor.

Posted in Australian eHealth

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