What is NEHTA up to with Shared Electronic Health Records, HL7 and so on?

Last week we had the following announcement from NEHTA.

http://www.nehta.gov.au/index.php?option=com_content&task=view&id=182&Itemid=144

“NEHTA sets direction for electronic messaging in health

NEHTA confirms Health Level 7 as the national standard for the electronic messaging of health information across Australia.

Across the Australian healthcare sector there are many different types of computer software and systems that are involved in the exchange of information. Currently, these systems use various exchange formats to send and receive information. To ensure that all systems across Australia have the ability to reliably and safely communicate with each other, a standard exchange format is required. The National E-Health Transition Authority (NEHTA) has determined that this standard will be based on the HL7 family of standards.”

NEHTA's roadmap for deployment and adoption is outlined later in the press release:

“To assist the health IT sector to migrate to this standard, NEHTA has identified the following approach:

a. Where HL7 version 2.x standards are already extensively used and yielding benefits, for example pathology and patient administration, these standards should continue to be supported. Where HL7 standards are not in use, they should be factored into system upgrades where practicable.

b. NEHTA will now focus on developing Web services specifications based on work undertaken by the HL7 Services Specification Project (HSSP), and content specifications based on the HL7 Clinical Document Architecture – Release 2 (CDA R2) for areas such as referral, discharge, prescribing, dispensing and pathology.

c. This work will then form the basis by which industry will migrate to HL7 version 3.”

This is really quite a large ‘change’ or dare I say ‘leap’ for NEHTA – so large in fact that a search of NEHTA’s “National E-Health Standards Catalogue - Supporting Standards Implementation - Version 2.0 - 19/01/2007” (8 weeks ago) does not have a single reference to HL7!

This is actually quite surprising given that HL7 V2.x was recommended by DH4 for continued use by the Australian Health Sector over 12 months ago and indeed it is widely deployed and Standardised nationally.

What is of major concern is not that NEHTA can show flexibility, but that they can show so much flexibility in moving from their previously announced path to this current path so quickly. Quite frankly, to put it bluntly this is not how Standards Development Organisations – even amateur ones – should behave. Were I a Health IT developer who had invested time and money in responding to NEHTA's previous Generic SOA approaches I would surely be suggesting that I would like my money back (with interest)!

This kind of strategic instability reflects a serious lack of real industry consultation over the last three years. There should be some accountability moment or action associated with this switch.

It is also difficult to understand why in NEHTA’s document entitled “Guidelines for Implementing Interoperable Web Services Version 1.0 – 28 March 2007” there does not seem to be any mention of either HL7 or HSSP. A comment as to where this new direction for interoperability with HL7 and HSSP fitted with this implementation guideline would have been useful and informative to everyone!

Indeed the delay in coming to a view of the place of HL7, given the expertise and advice available to NEHTA, is really unconscionable and has been a major barrier to e-health progress. One could have expected strategic clarity in the area much before this.

One must also wonder with the decision to deploy content based on CDA R2 just where all the NEHTA Clinical Data Specification work fits and how much of this will need to be altered or reviewed to conform with the HL7 Reference Information Model? It would also be interesting to know how all this fits with the long delayed but imminent Shared EHR announcements.

A final point - does anyone else think making a decision like the HL7 decision warrant a process of open public discussion and not simply an ex-cathedra announcement. Some of us don't worship at that sort of church!

Talk of the right hand not knowing what the left hand is up to.

David.