Dear Colleagues, Since the mid-1980s we have seen the advent of the mobile phone, the internet, e-mail, e-commerce and a myriad of electronically connected services. You can easily book a plane ticket on the internet with multiple systems communicating and interoperating on the semantics of your travel requirements. But in healthcare, we still cannot book medical appointments on-line and the electronic exchange of pathology results, although work started on Pathology Standards in 1996, is still challenging. What is the Problem? Diagnostic service messages that are delivered electronically use a mix of the non-computable PIT display format or an implementation of HL7 V2.x which may not meet certification and/or may not interoperate. However, there exist agreed Australian Standards covering pathology messaging (AS4700.2) and radiology (AS4700.7) as well as a detailed Implementation Guide (HB262) for pathology messaging. The Pathology Standard and Implementation Guide is in the process of being revised and are the basis of a new effort to achieve compliant interoperable messaging. The pathology messaging Standard currently recommends LOINC ("AustPath"), but has not been nationally implemented. More recently, SNOMED has been endorsed as the national clinical terminology. The messaging encryption and security varies from system to system and doubt has been recently cast on whether Medicare Australia (HESA) will continue to provide "electronic certificates" for use outside Medicare electronic billing. Healthcare messages still are not exchanged using a common standard format, but seem to require proprietary point-to-point connections resulting in users such as GPs having to install and maintain an increasing number of communication software on their systems. NEHTA have flagged the move to web services, but it is not clear what that means in the context of messaging. The effect of these problems is that standards implementation for many is still more "Plug and Pray" than Plug and Play! So, What is the Solution? Almost everyone agrees that there is a need to implement more easily interoperable solutions based on a limited range of existing standards (messaging, vocabulary, identity management, security & transport). The problem is not the lack of standards or even too many standards; the problem is how to achieve consistent and compliant standards implementations. The soon-to-be-released revision of the NPAAC Laboratory Accreditation Guidelines is expected to require that pathology messaging be certified conformant to the AS4700.2 Standard by 2009. There is uncertainty in Australia as to how best to tackle the "standards implementation" problem. Internationally, the Integrating the Healthcare Enterprise (IHE) methodology has achieved effective implementation and verification of interoperability. Locally, HL7 Australia introduced the IHE methodology, scope and achievements in 2004. However, since then progress has been slow due to unfamiliarity with the IHE process and the unclear role of web services in healthcare communications. Recognising this uncertainty, HL7 Australia, the Health Informatics Society of Australia (HISA) and the Medical Software Industry of Australia (MSIA) have agreed to cooperate to work with users and industry to provide a platform for implementation of interoperability standards using an industry-led approach. This will pay careful attention to the emerging NEHTA interoperability framework, yet intends to deliver results today drawing on approved Australian versions of key international Standards . Within this collaboration, HL7 Australia is holding a Workshop on Diagnostic Messaging Implementation using the IHE methodology which will succinctly identify and confirm the current barriers to effective interoperability in Pathology/Radiology messaging and then commence work on and Australian IHE-style diagnostic messaging profile. The expected outcome is a certifiable HL7 V2.x profile for Pathology/Radiology messaging. We look forward to seeing you at our Pathology Messaging Implementation Workshop! Klaus Veil Peter MacIsaac
Chair, HL7 Australia Workshop Convener, HL7 Australia Note: The cost of this Workshop is $400 for Members of HL7 Australia, MSIA and includes a Learnings Review for participants wanting a Certificate of Achievement. | 
