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 10:00 AEDT

Meeting 41


Jared Davison

Thomas Ellis

Anthony Cruice

Andrew McIntyre

David McKillop

Eric Browne

Isobel Frean

kyle macdonald

Michael Legg

Rueben Daniels

Dalisay Giffard


  • The following discussion is around feedback on HL7 Board's "HL7 Australia response to Australian Digital Health Agency Draft Interoperability Plan"

Isobel Frean introduction as the new head of HL7 Australia
Reuben introduction as a HL7 Australia board member.

Michael asks for feedback
David's was that conformance is the missing link. Unless people are made to conform its not going to work.
Andrew's feedback most technology immature. V2 has been able to do what is required but no uptake.

Michael Legg listed needs and almost all is missing from the national plan. Needs to be added.
The colleges in medicine need to be engaged or it won't work.

Dalisay: There is no meaningly adoption from a business or clinical context. No matter the products being created no reason to adopt from a business sense.

Andrew: colleges aren't capable enough to make comment.

Michael: Asked for consensus on sending 2 paragraphs on what he said.

Isobel: 2 pages is a modest extract from a working document.
What is the strawman on this and costings etc.

Jared: reminds me of NEHTA saying CDA will do everything and replace HL7v2. Never eventuated.

Andrew doesn't agree with point 2 that we move to FHIR. There are cases that aren't covered in FHIR. Standards that are in use should be used. We have a balloted standard that can be used. Atomic cancer reporting covered in v2 not in FHIR.
Implementing things well is difficult. Starting with something people already have is a shorter path than starting fresh. If you want to do something now improve V2.

Michael: NATA the owners of NPAC Requirements have no idea how to test for conformance. Unlikely in the timeframe required.
Speaks of consequences from not adhering to the standard.
A long time to move to FHIR for ordinary pathology work.
Take quality assurance process and apply to informatics.

Isobel: Spoon feeding is required. Concrete advice is required.

Andrew: Only thing is missing is conformance testing is required for v2. Compliance for receivers is urgently needed so the senders can send with no business disadvantage.

Michael: Free help to government is running thin. People need to be paid to do it properly.

Andrew: Take what we are doing now and make it compliant. No objection to developing FHIR but saying it's all too hard and move to FHIR. Thats another 10 year timeframe to get something practical. Cites current problems in FHIR provider directories.

Dalisay: Separating structure from payload to the content. Content is always going to be less than average unless the services are made safer. Current variation of Radiology report is awful so no matter the structure unless it's standardised.
National Health Identifiers - Isn't the answer to patient to identity. Bridge the gap between the technical layer into the business context.

Andrew: Agrees with Dalisay.
Everyone dumbs everything down to text or PDF because that's what works. As the receivers are non compliant the senders dumb it down to get the business.
The receivers non compliance is the crux of the matter and what is holding us back.
Crux should focus on endpoint quality and compliance.
Focus needs to be on receiving endpoint quality. This enables senders to produce high quality messages.

Eric: Generally in agreement with Dalisay and Andrew.
Doc from agency should talk about more about existing standards.
Those standards are going to be supported and a good foundation into the future.
FHIR opportunities haven't been well articulated. Point 2 in the document negates what we have and doesn't articulate what advantages FHIR will give us.
Conformance is a very big issue but even that isn't sufficient. Management of terminologies haven't been done. Doesn't cover the breadth Meteor. Agency doesn't have a good track record with terminologies.
Endorse what Michael said about needing good policy settings in his paper.

Kyle in agreement.
Recipient wants something that looks pretty. Don't understand or willing to understand the value of something that looks pretty vs value to an EMR system. Recipients not willing to consider the value of atomic because they don't currently experience it. FHIR has plenty of good things but it's the same problem that the valuable information still needs to be supplied. Changing the car but the road is still broken. Carrot and stick to the vendors to make use of valuable atomic information. That makes the users want information to be delivered like that.

Dalisay: The secondary uses of the information, needs to be pushed to primary importance. Immediate benefits that could save billions dollars in health care if information could be obtained in a high quality structured. If it has been enriched with structured terminology.

Andrew: Receivers can ignore the atomic information it's just as long as they don't crash when they receive them. Need to be able to send good quality data to receivers without them falling over.

Jared: FHIR won't fix it. Vendors have their efforts splintered into multiple places and it won't be done well.

Isobel: Not their intent that FHIR is the primary. Wording may have been better considered. Will redraft point 2.
It is definitely clear that V2 is very important.
There is an intolerance to hear the history in government and learn from it. Need simple and clear ways to address issues in a way that is complimentary. A consultant will be paid to write something for ADHA.

Michael: it's about the users of the information not just GPs

Andrew: There is no incentive to fix non compliant systems.

Reuben: Asked what ADHA can do about it.

Andrew: A testing procedure with batches of messages to stress a system.

Reuben: Is Andrew suggesting ADHA take on that function.

Michael: Not necessarily but a compliance tester is needed.

Reuben: Vendors don't want to be dictated to by government.

Michael: It's standardisation vs innovation but there are safety things that must happen.
Pathology the rules already exist and other disciplines need it.

Dalisay: The commission is doing this. Australian Commission for safety and Healthcare.

Reuben: What does the Agency need to do then.

Dalisay: Agency need to do clinical governance. Patient matching on name etc example supplied. Is it safe. Are the IHI being used in the way they are meant to be. ADHA needs to create resources that form the basis of compliance. Needs to be understood in a way that can be understood by clinical owners.

Michael the Patient example is a safety issue. If you have the wrong patient you're going to do harm.

Dalisay: Went to the commission asked for the rules for safe software in practice.

Andrew: Most important thing is display. Enormous safety issues if the report does not display correctly. Vendors will want payment. We want to make sure end users are seeing a reliable rendering of what is sent.

Michael: Use the existing systems and help them to do what they need to do to keep patients safe and improve health outcomes.

Isobel: Welcome comments critiques. First rough draft.
Provide as much tangible reference to what already exists or other ideas for filling the gaps.

Reuben: We have an opportunity with the agency. Try to work with the agency and not against them. Make the most of this opportunity now. In relation to the conformance supply how it needs to be fixed. They don't know what they don't know.

Andrew: In the response we need immediate action point on safety needs to be addressed urgently. Happy to say support FHIR in the future.
Safety through compliance is the priority with what we have now.
Need longer term plan to get standards back on track.

Isobel: Turn this into a safety message. Will give us a broader audience.
Submission due on the 13th of December officially. Follow up tomorrow with Amanda. Planning on asking for some more time. Next board meeting on the 15th of December.
Happy to share next working draft.
Want to get a response before xmas.
Also happy to share next working draft around conformance recommendation.
Would like dot points for inclusion into response.

Andrew: Conformance for safety should be number 1 priority.
Eric and Medical Objects have online testers. Examples on testing.
AHML tester was allowed to die.

Michael: Report being sent has information on the testing.

Eric: Wait for HL7 Board feed back before we respond.

Andrew: Another meeting required before it is submitted.

Michael: High level needs to be right before we go into detail.

Andrew: Immediate intervention then a long term plan to get things back on track.

Andrew appears there is development of FHIR separate to our group.

Michael: We would like to be part of any FHIR development as we have a contribution to make.
There appears to have been quite a lot of development without a conversation with orders and observations.

Isobel: Board is looking at the structure of our standards and working groups.

Michael: The group has been around 25-30 years and the

Jared reading Angus's email. ADHA is developing the FHIR diagnostic profile without consultation and involvement from HL7 AU OO.

Next Meeting

  • Isobel to provide Jared for distribution to OO draft ahead of next meeting.

Next meeting 14th December 13:00 AEDT.

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