file size that presently can be transmitted between practices, the sender is advised to insert a CD and, unless a record is marked confidential, everything is sent or copied to the CD. 128 bit encryption is used and the CD can only be read by the appropriate receiving software. It would therefore not be possible for the patient to take the CD on holiday to India to use as a complete medical record! Confidentiality around encounter notes is maintained. Even when a medication is attached to a confidential record the medication is sent and the associated note can be omitted. Jenny’s new practice will receive
the transfer notes as a message in their HealthLink in-tray. The message is exchanged as a CDA HL7 V3 document. Because there must be no dispute as to what has been sent, this document also contains the complete patient record in human readable format. The receiving doctor may decide that a record of a runny nose when the 25-year-old patient was three is not really necessary and may decide not to import this particular encounter note. As an aside, this optionality is currently
a point of considerable controversy between doctors. One school of thought says that the doctor must import everything because that runny nose might be important in another context, and another is equally emphatic that they only want what they want. This debate is still to be resolved! The receiving doctor can click the
‘Import All’ button, in which case allergies go to allergies, prescriptions go to prescriptions and medical notes go to medical notes. Pathology and radiology reports are also correctly filed. If Jenny knew which practice she was
going to before she left Christchurch then she could have signed the record transfer
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request form there. As long as she had enrolled in the new practice, everything would be waiting for her and her two children when she arrived. Obviously these are early days, there
will be enhancements and feedback to be actioned and there is much more to it than described above, but for $750,000, what a bargain! NEHTA are you listening? This is also a very important example of what you can do with standards. For the technically minded and industry
insiders, now comes a particular gripe and a plea to my competitors and colleagues in Australia. Since Houston Medical started supplying software in Australia in 1993, we have had a constant battle with standards, in particular with PIT, the ‘birth’ of which I am old enough to remember well. Around 1996 I was with a Brisbane
pathology lab and I asked if they could send lab results to a dermatology client in the HL7 format which we had been using in New Zealand for several years. They looked at me aghast and I quote: “Australian software would not be capable of receiving an HL7 message and we have devised something easier to implement called PIT”. And now, in 2011 doctors are still
sending and receiving Referral, Status and Discharge (RSD) messages and even worse, having radiology results forced upon them in the PIT format, even though it is non-standard and, in my opinion, should have been put out of its misery and buried years ago. For those not acquainted with HL7, it is
an international standard that was devised by Duke University in the United States in the late 80s for the secure transmission of health results from one facility to another. In New Zealand under the guidance of HealthLink, all messages between doctors and all pathology and all radiology results
have been HL7 compliant since the mid- 90s. Over the years HL7 has evolved from version 1 to version 2, and then through various iterations of version 2. New Zealand has moved to version 2.4 which allows the inclusion of an embedded PDF so images and letters can all be included. Version 3 is under consideration and is used in the GP2GP CDA message. Australia, unfortunately is still
struggling to mandate even version 2.3.1. The Royal College of Pathologists Australasia mandated the use of HL7 three years ago, but unfortunately the Royal Australian and New Zealand College of Radiologists still has to make a decision. The transference of Referral, Status and Discharge messages between doctors and hospitals cannot sensibly move ahead until the HL7 international standard is accepted across all health disciplines. Therefore I close with a personal plea
to the software vendors of Australia that need to implement the transfer of medical records from one practice or health service to another. If you really do want to embrace an eHealth record like the PCEHR, then standards are essential and the first move you should make is to ensure that all RSD messages between doctors and all reports from radiology and pathology are sent using the internationally accepted HL7 standard.
References 1.
http://www.ithealthboard.health.nz 2.
http://www.houstonmedical.net 3.
http://www.mypractice.co.nz 4.
http://gpnz.org.nz 5.
http://www.ithealthboard.health.nz/ primary-healthcare-it-programme- group
6.
http://www.intrahealth.com 7.
http://www.medtechglobal.com 8.
http://www.healthlink.net
Pulse+IT 9
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