A demonstration of Australian Innovation

and capabilities in Health Informatics

Jared DavisonB. Inf Tech (QUT), B. Eng (QUT),

M. IEEE, GradIEAust, AACS.

Software Engineer Medical Objects

Sunshine Coast, Queensland, Australia

Report & Referral Distribution Network• Real-time HL7 Transmission of

– Specialist reports– GP referrals

• GPs

• Specialists

• Allied Health – psychologists, physiotherapists, dieticians, optometrists

• Radiology

• Pathology– Including distribution from Departmental Pathology Services – Gateway messaging services

• Disease Registries

• Nursing Homes

Report Distribution• Integrate with existing practice software

– GP computer systems– Specialist computer systems

• Report delivery into GP software is an unattended operation

• All transmission in HL7 format, encrypted & signed

• Imported by GP computer system – same as pathology import

Medical Objects Network Today

Medical ObjectsSo what is HL7?

HL7 = Health Level 7

7 = application layer in OSI model

Open standards based architecture

• Active HL7 R&D program since 1999.• HL7 USA member since 1999• HL7 Australia member since inception

• Standards Australia Pathology & Radiology Messaging committee member

The pieces• Data Acquisition / Systems Integration

• Transport

• Recipient/Provider Addressing

• Delivery & Acknowledgment Protocols

• Security & Authentication

• Routing

• Network topology

• Use of standards – HL7

Specialist report acquisition• Specialist report

creation– Word Processor

integration– HL7 based

custom reporting clients

GP referral acquisition• GP referrals

– Captured from clinical practice software

– Digitally signed PKI USB key

– Encrypted with PKI certificates

– Encrypted provider lookup– Zero configuration install

• Reports are delivered real-time

GP Referral

DigitalSignatureBlock

Transport• Internet access assumed

• Consideration of OSI Layer 6 protocols– HL7 over HTTP

– HL7 over Email

– HL7 Lower Level Protocol

HL7 over HTTP• Advantages

– HL7 standard acknowledgement possible– Ability to reject connections

– Industry standard– Ease of interoperability for 3rd parties– Connectionless scalable– URL & Headers available for protocol variations

• Eg. Http1.1 keep alive, content types

• Disadvantages– Need for full time internet presence

Provider Addressing IssuesAustralia Government issues Provider numbers for each

doctor

– Specified by Australian HL7 Standard– Check digit scheme– Location Specific– Virtually always obtained (billing)

• Are doctors issued with a centrally controlled identifier in Singapore/Malaysia for each location of practice?

• Are all health workers care providers allocated numbers?• Public hospital doctors• Nursing homes• Allied health• Nursing staff

Address/Recipient Lookup• HL7 2.3 Master files

– Defines messages for maintenance & query for providers using the STF segment

– CH 8.3.3

• Solution: Master files implemented

HL7 Master Files Query

HL7 for Mere Mortals

Delivery Protocol• Standard HL7 Delivery Protocol

• Message Acknowledgement• Eg. ORU – ACK, REF – ACK (messages)• Assumes

– Internet server availability– Push model as new reports are sent unsolicited

(ORU)

• Retry sending if ACK not received

• Custom HL7 polling protocol also available

Security & Authentication• Encryption used for security• Digital signatures used for all authentication• 1024 bit public keys only• Encryption Mechanisms:

– X.509 Certificates / PKI– Native PGP compatible (explicit trust model only)

• No usernames / passwords – (weak security)

• Is there a health provider certification authority here?

Routing• Enable communication between practices

and doctors running independent systems.

• Manual configuration of connections between every practice is not feasible– Because the number of direct path

configurations required is• n(n-1)/2 (where n is the number of independent

systems)

• Internet enables virtual/potential connections

Routing• Solution: use HL7 Master File messages

to enable dynamic discovery of newly connected users

• Allow existing users to change their address without manual reconfiguration being required

Distributed nets.• Distributed network (fully connected mesh)

– Every node is able to communicate directly with any other node

– Fewer points of failure in transit– Very powerful

• Load sharing possibilities

– Parallel communication– Very Fast– DDoS can at worst case affect

limited nodes only– Robust to natural disasters

HL7 Servers• Servers

– Message encoding supported• HL7 v2.x (Classic & XML), PIT

– Win32 platform– Multi-tier architecture

• SQL database tier (Linux or Windows)• Application server tier

– Replication supported (over HL7)– Standalone Service IIS (ISAPI) or Apache (module)– run locally or in Application Service Provider (ASP) mode– Persists 10,000+ messages per hour (Athlon 1.5GHz, 7200 RPM, 512 RAM)– Serves queries many-many times more!!!– Interface engine

• Server Types– Lightweight GP receive only (file based db)– Gateway– Distribution– Practice– Provider Directory– Terminology (SNOMED, ICD10, MIMS, LOINC)– Routing

GP Solutions• Receiving Specialist Messages

– Polling Client (works with Distribution Service)• Win 32 platform (95, 98, ME, NT4, 2000, XP, 2003)

– Tray Icon service– NT service

• Linux• Mac OS X• Any future PKI Supported platform• Integrated PIT conversion• Acknowledged delivery

– GP Reception Server• Acks messages and saves as files• Win 32 platform (95, 98, ME, NT4, 2000, XP, 2003)

• Simple download setup 4.2MB• Easy install – no reboots or downtime

GP Solutions• Sending Referrals

– Win32 (98, ME, 2000, XP, 2003)– PKI Signed referrals– PKI Rainbow iKey required

– Setup: • 2.7MB internet download • Zero configuration easy install• no reboots or downtime

Specialist Solution• Sending Reports

– Word Processor integration• Word 97, 2000, XP, 2003• Word Perfect 10

– PKI signing possible

– Patient record access and authoring– Patient result analysis & graphing

– Setup• 3 MB download• Easy & quick install• No reboots

Contacting Medical Objects

• If you have any HL7 related problem we would love to help you solve it.

• 400 brochures – take a few for your collegues

http://www.medical-objects.com.au

info@medical-objects.com.au

Medical-Objects: +61 7 5456 6000