Australia’s eHealth plan
It seems that after spending over $300M trying to kick start eHeath we are going to have an eHeath plan! Seems to me like that is a very good idea and the question is why don’t we have one already and what should be in “it”.
It’s an eHeath plan drafted in 3 months and will last 5-10 years! Still doesn’t sound quite right to me but any plan is better than no plan. Unless something major is changed its likely to be formulated by people with more political clout than technical expertise so maybe some ideas from the trenches would help.
Firstly, we don’t want a grand plan as they usually fail. We want to put in place measures that get us to a point that a grand plan is a possibility. A grand centralised EHR will not work unless everyone is using standards for their every day eHeath dabblings. That’s where the plan should focus. Australia has widespread usage of HL7 V2 and thats what we should aim for, but at a better level of quality. HL7 V3 has some nice modelling but is is not ready for widespread usage yet and the NHS in the UK is pouring buckets of money into that pond so we should swim in the functioning pool. CDA is not really any advance on good V2 and while the xml might be easier to parse it has no support in the current primary care applications and should not be an immediate target because of this.
What we don’t have is good quality HL7. The labs produce it but the receivers are fragile and the lowest common denominator is limiting what we can do. We need to have certification of the HL7 produced and certification of the applications ability to consume it. If this was done correctly then the reliability and quality of our clinical messaging would soar. We already have AHML able to certify HL7 produced and test message sets to test on applications so its easily organised! The State Heath Departments should be forced to only spit out 100% pure AHML accredited HL7, its not safe to do anything else and I am sure it could be done give enough push.
We do need provider directories, but almost all the lab messaging uses Medicare provider numbers for this and it works well. The grand all singing and dancing provider directory is a way off so why not use something that just works. Medicare Australia need to loosen their grip on the monthly lists of provider numbers for this to work but I am sure this could happen with only a modicum of counselling.
We need standards that allow you to send an entire patient history in HL7 V2 including SNOMED-CT encoded concepts. The archetypes in V2 project has the ability to allow this but this project has been running on a shoestring. Standards Australia needs to have its eHealth budget lifted by about 10 times. Currently there is one 1/2 time person for all the eHeath standards! Projects like this should have a full time person on them. It can take 2 months to get a document edited. This is not a Standards Australia problem, but a lack of funding support issue and it needs to be fixed ASAP. Someone, who can read and write HL7 in their sleep needs to be employed full time doing examples and testing concepts. Currently this is done by volunteers at midnight the night before the meeting.
We do also need messaging of course, but we need good quality messages before this is actually useful. The most useful option here would be to produce a standard and mandate its use. Even producing a standard would help as at the moment the “Use WS-Security” is nowhere near enough detail! How could this be done, this one would take some bravery but throwing together 10 technical (Not political) experts from the companies involved for a week with the expectation of a draft standard at the end of a week is probably the best option. Once that is done you could legislate that the receivers paid for the service if you were really brave. Next issue a directive to HESA (Now inside Medicare) to issue a site certificate and Individual certificate to everyone with a provider number and do it every time a new number is issued. You would also insist on a certificate signing service so certificates could be generated onsite, maybe using a valid individual key to upload it for signing.
Now drugs, we need SNOMED-CT codes and they need to be in the PBS by the end of the year. They also need to be integrated into the SNOMED-CT hierarchy so we can use them for decision support. A ministerial to advise that this must be done by the end of 2008 is what’s required here. SNOMED-CT may not be perfect but expecting clinicians to take responsibility for patients with no viable decision support is just not fair. When we have this we can look at scripts as they are just HL7 orders.
Next we need some money for all this, Standards Australia just need a one line budget, but perhaps we could add a”e” in front of every consultation/script that was messaged using AHML accredited HL7 and Medicare could pay the doctor/lab/pharmacy a premium and link all future rebate increases to this. That would certainly make it happen and you would only pay for performance. Its pointless paying vendors big $ to implement “X” – it has not worked. Reward some rubber on the road.
Ok, there it is, a 30 minute eHeath plan. All it does is put some onus on people to do what they should have already done and throw away the idea of expensive central systems and replace that with some good solid tested code in the trenches. That’s what we need.
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