AUTHOR: Tom Bowden, CEO, HealthLink & Vice President, MSIA
Every now and then I need to remind myself that the endless rounds of meetings to discuss Secure Message Delivery and interoperability are truly necessary and must be persevered with.
Why is Secure Messaging so difficult?
Let me count the reasons.
Among the four or five secure messaging companies operating within Australia there are a range of different approaches to the task of delivering clinical messages securely and reliably to their various customers, all of whom wish to be able to communicate with any other healthcare provider. In terms of core technologies, some use FTP (the File Transfer Protocol) others use SMTP (otherwise known as email). Each company has its own service levels. And then there are the differing business models; some charge per message, others offer a flat fee, some have commercial support arrangements with the electronic medical records vendors, others do not.
Agreement on access to electronic directories relies on use of the latest online technologies. All messaging vendors must ultimately be able to use multiple, federated directory systems, a number of these systems are currently under development and they need to be made compatible and 100% reliable. The national infrastructure for electronic signatures hasn’t worked particularly well and so needs modification which requires effort as well as buy-in from all of the secure messaging providers. The method of identifying healthcare providers needs agreement from across the sector.
The list goes on and on. This is why we have so many meetings, working groups, task forces and committees.
Why is secure messaging so important?
Health systems across the world are groaning under the pressure of an ageing population and unsurprisingly an ageing workforce. To view the problem through an economist’s lens, Australia’s expenditure on healthcare accounts for 9.4% of the country’s gross domestic product (GDP). Over the past decade this proportion has expanded by 28.7%.[i] The pressure that this level of increase is placing on Australian society is unsustainable. Solutions to lowering the cost of healthcare must be found.
Use of electronic messaging is something that could really change the game of healthcare delivery. In other countries it has already done so. Much of Australia’s healthcare is delivered by general practices, these are of course the medical organisations which provide most of us with the majority of our day-to-day healthcare. In order to do this they must constantly communicate with laboratories, radiology services, specialists and hospitals that help them to manage our care. Therefore, the more efficiently and effectively general practices can communicate, the more effective the overall health system is.
Unfortunately, Australia’s general practices are not yet able to take advantage of integrated information technology to the extent that their international counterparts are able to. This is actually quite serious, some might call it tragic. Let’s look at a few numbers. Fewer than 5% of Australian General Practices say they expect to receive discharge information within 24 hours of discharge (this interrupts continuity of care) and of those, 47% say they usually receive the information by fax! Only 18% of GPs say they always get notification that their patients have been seen by an emergency department and the same number (18%) say that they always receive notification that their patients have been discharged from hospital.[ii] All of these figures point to a woefully integrated healthcare system.
However, the good news is that there is an awful lot of room for improvement. This brings me to my point which is that it is vitally important that we as a health IT software industry seizes the current chance provided by ADHA and the Australian government to finally solve this problem.
There is a tide in the affairs of men. Which, taken at the flood, leads on to fortune; omitted, all the voyage of their life is bound in shallows and in miseries. On such a full sea are we now afloat, and we must take the current when it serves, or lose our ventures. – Julius Caesar Act 4, Scene 3