Doctors get the message

29 Jan 2004

A new standard recently established by the Health Boards Executive (HeBE) is paving the way for the introduction of a nationwide messaging system that will enable GPs to process lab results and other hospital-to-GP communications in a speedier and more efficient fashion.

This type of service was pioneered in Dublin by Healthlink, which was based in the Mater Hospital. The Mater and several other hospitals in the Dublin region have been using the service to great effect. Normally when a patient is referred to a hospital for a blood test or X-ray, it can take up to a week for the results to be sent by post to the GP. Healthlink, however, enabled results to be sent within 24 hours directly to the GP’s PC. The pilot project was such a success that doctors outside the Dublin region began asking if they could use it. These requests had to be turned down, although at least one hospital in the Limerick region began using the Healthlink technology.

However, Healthlink had its limitations and there was a risk that different health boards could adopt different technology that could create problems for interoperability in the future. Accordingly there was a push to develop a nationwide standard and this was agreed before Christmas.

“Over the past five to six years there have been several different projects trying to achieve the same thing,” says Kevin Peyton, project manager for HeBE. According to Peyton, the impending reorganisation of the health service meant there was interest in developing a common standard and HeBE was the perfect forum to bring together all of the players.

From Peyton’s point of view there were two ways of looking at the issue. “Firstly, all of the health boards were interested but each had different expertise and knowledge. Secondly, a number of health boards may have been holding back because of the very lack of standards. You have to bear in mind that the endpoint for a lot of information is the GP’s practice management software,” he explains.

Without a standard, says Peyton, there is no incentive for the vendors to incorporate it in their software because any work they do for one health board would have to be replicated to accommodate another health board.

Another factor was that there hadn’t been any forum for the players to come together. “HeBE was the idea,” says Peyton. “As I’m fond of saying ‘the planets were aligned’ for this technology to roll out now as opposed to five years ago. All the concerned parties can use the technology securely and safely.”

But why develop a new standard in the first place? Why not simply use an existing product such as Healthlink?

“As far as I am aware the message formats in Healthlink were proprietary,” recalls Peyton. “Also messages were human readable because one of criteria of Healthlink was they could be read in a standard email message.” HeBE wanted something that could be integrated directly into the practice management software but which could also be read by the GP. As Peyton points out, XML (extensible markup language) is still human readable but more obscure.

After much discussion, the HeBE opted for a standard developed in the US called HL7 but adapted it to use XML syntax. According to Peyton, from the practice management software developers’ point of view it is easier to extract the information from back-end systems and manipulate it with middleware software.

There was also considerable discussion over which version of HL7 to use. “HL7 has undergone a lot of development over the past few years,” says Peyton. “We looked at various standards and as with any there is always a latest and greatest version. However, we felt that HL7 v3.0 was a bit too bleeding edge. We felt that there was a slightly high risk of going with something that wasn’t proven. Also, the tools weren’t ready and the user community was small. There may have been advantages to v3.0 but we decided to work with version 2.4, which is proven and used extensively in the field.

According to Peyton, the standard has been rolled out in the North Western, North Eastern, Southern and South Eastern Health Board regions and in Dublin and the Mid Western Health Board Regions where Healthlink was first introduced. Reaction, he says, has been uniformly positive.

“This is information that up to now has been delivered usually with considerable lag time by fax. You have worried patients ringing the GP and the lab. Now, however, once the lab results have been authorised by lab staff they are available immediately. Also the results don’t have to be re-keyed. You can imagine the amount of time saved in practice management.

“My own personal view is that this is going to create a huge demand for other clinical information. We have seen that once you show someone that something can be made more efficient they will typically ask what else can we use this technology for. Laboratory and radiography results will remain the core deliverables but we are working on using it for accident and emergency attendance, admission and discharge notification, death notification and out-patient appointments.

By David Stewart