In November 2015, Mettaloka Halwala, a Sri Lanka-born father of two, went for a PET scan at Goulburn Valley Hospital near Shepparton, Victoria.
Halwala, who had moved from his home in New Zealand to work as a civil engineer for Goulburn Murray Water, had been receiving chemotherapy for Hodgkin’s lymphoma, but his latest PET results suggested he may be suffering toxicity as a result.
Two days later he received another dose of chemotherapy, which only happened “because the haematologist…was unaware of the results”.
Days later, having called his doctor to say he was feeling unwell the night before, Halwala was found dead in his hotel room.
“He never made it,” the coroner’s report into his death read.
The haematologist never received the PET scan results because they were faxed to the wrong number.
“It is difficult to understand why such an antiquated and unreliable means of communication persists at all in the medical profession,” wrote Coroner Rosemary Carlin, and called on the hospital to phase out the faxing of imaging results as a matter of urgency.
In August last year the Council of Australian Governments Health Council approved Australia’s National Digital Health Strategy, a key priority of which is to end dependence on the fax machine and paper-based correspondence.
To fully replace the fax, however, medical practitioners need a replacement that allows for secure messaging of records and results which works on a wide range of clinical software.
This month, government agencies, the medical profession and industry met to nut out some standards and agreed formats for messaging.
“Health information is stored in diverse health software and frequently needs to be shared. Without interoperability, this information may need to be scanned and faxed or even posted. Not only can this be dangerous but also highly inefficient,” said Medical Software Industry Association (MSIA) president Emma Hossack.
“To share and manage access to health information, we are working towards adoption of agreed compliant messaging standards, conformance at the receiving ends, and a federated approach to directories. This will make health communications more seamless and safe,” she added.
The meeting, hosted by MISA, the Australian Digital Health Agency and the Royal Australian College of General Practitioners was attended by 53 members from clinical and secure messaging software suppliers and industry stakeholders.
They agreed to support both HL7v2 and CDA messaging formats through the medium term and focus efforts on improving message payloads to improve compatability with clinical work flows.
Criticism was levelled at the National Authentication Service for Health (NASH), which provides Public Key Infrastructure (PKI) Certificates for those wanting to send information to the My Health Record and in secure messaging.
“Participants expressed concern regarding the current system’s responsiveness. NASH does not adequately meet the needs of messaging providers and their customers; both the process to obtain a certificate, the time delay in certificate issue, and the problem rectification process,” a communique from the meeting noted.
The ADHA said it was working with the Department of Human Services to improve service levels. The agency also agreed that privately issued certificates have a role in secure messaging, where those certificates meet appropriate standards, a sentiment backed by software providers.
Proof of concepts around interoperable messaging are already underway by both Telstra Health and HealthLink.
Telstra Health is leading a consortium to test the delivery of discharge summaries from Royal Melbourne Hospital to a number of general practitioners. CorePlus, Genie Solutions, Global Health, HealthLink, and Zedmed are also participating in this project.
HealthLink is leading another consortium testing the delivery of referrals from a range of GPs to specialists in a project involving MedicalDirector, Best Practice Software, Genie Solutions, Global Health, and Telstra Health.
Both consortia are finalising a federated search capability which will allow for the searching of provider directories and care provider electronic addresses. This means that a single search will identify Australian healthcare providers, providing an easier way for clinicians looking up other clinicians. The sending of messages across these sites will commence this month. The projects have also been extended to include allied health practitioners and electronic medical record products.
“Secure messaging systems and standards have been in place for many years, but as a country, we’ve struggled to implement at a national scale,” said ADHA chief operating officer Bettina McMahon.
“It has taken time to co-produce a workable solution with industry that meets the expectations of the clinical community – we started this project 18 months ago. But to adopt a true co-production process takes this long, and ultimately, has allowed us to reach consensus about how we will scale digital communication,” she added.