February 18th, 2007 andrew
Thats what Medical-Objects is working on at the moment? Our realtime clients are now starting to be more routinely deployed to receive data and increasingly to send data.
These clients live behind firewalls but have a public web based interface that supports SOAP and Http interfaces.
They exist in environments that could not and should not be opening listening ports because of lack of IT support. How is this done – by applying the “Proxy Pattern” Medical-Objects are now running a suite of proxy servers who will hand encrypted data to the waiting clients and then forward the response back to the sender in realtime. This is not store and forward, but realtime connectivity. All HL7 processing is done at the client.
This means you can deliver results directly to GPs desktops and know that it got there (or did not) in realtime. Combine this with an mind boggling array of prebuilt and tested message transforms and you have a distributed flexible realtime secure network. Clients can even run off multiple proxies to reduce to potential for a single point of failure and all messaging is point to point.
Obviously this model needs services, we have well tested routing directory and provider directory services to support this and the overhead is small. We estimate that that a single appserver could proxy 2000-4000 practices in this way.
Realtime messaging opens many doors for the provision of services and we are excited about the future of this technology. It makes EMail messaging look like the telephony equivalent of a telegram.
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February 18th, 2007 andrew
An observation, that has become more marked with time is the lack of technical people at HL7 meetings and Standards related activities.
This is a concern and most likely part of the eHealth “Problems”
This is matched by an increase in managers and bureaucrats in the same meetings. While certainly not confined to the health arena the lack of technical knowledge can make progress difficult. eHealth is in some ways similar to Health in the way it works. In health senior doctors do not progress into administration as their experience increases, but continue to apply their skills to patients and teach more junior doctors. A move into administration is regarded as a backward career step by most doctors.
In IT similar forces are at play. Without in depth knowledge and experience its hard to pick to glossy marketing from the innovative and solid solutions. Senior IT people, who still are active in development are a key resource to guide direction and teach junior IT graduates and many of the IT gurus of the past are respected as teachers and luminaries for their IT knowledge and not for their move into management.
Solid solutions that work are easily overlooked by non technical eHealth players and the sexy new “xyz” is “the way to go” even before a single working implementation is done.
Solutions that solve important problems well and reliably are ignored in favor of the latest solution, often because it done in “xml”
In Australia Pathology labs have been reliably producing and distributing quality V2 HL7 for nearly a decade now but somehow this is regarded as insignificant and too hard to apply more generally. Similarly encryption standards that just work are rejected for XML Encryption and digital signature. Its not that the new options are bad, its just that they are immature and largely untested in wide usage. Whats wrong with working reliable CMS/SMIME encryption standards that we know can work?. (and this is just one small example)
There is no doubt that eHealth is hard to get right, but it will never happen until we involve technical people as a core part of the process. Any new standard should have example implementations that we know work well and scale before we start rejecting technology that is known to work. I wonder how many members of the technical committees could actually look at a HL7 message and have any idea what it all means? Until the answer to that question is > 90% of the Committee we have a problem!
Its time we involved Technical People in the Technical Committees!
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