1. A demonstration of Australian Innovation and capabilities in Health Informatics Jared Davison B. Inf Tech (QUT), B. Eng (QUT), M. IEEE, GradIEAust, AACS. Software Engineer Medical Objects Sunshine Coast, Queensland, Australia

2. 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

3. 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

4. Medical Objects Network Today

5. Medical Objects So 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

6. The pieces Data Acquisition / Systems Integration Transport Recipient/Provider Addressing Delivery & Acknowledgment Protocols Security & Authentication Routing Network topology Use of standards – HL7

7. Specialist report acquisition Specialist report creation –Word Processor integration –HL7 based custom reporting clients

8. 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

9. GP Referral Digital Signature Block

10. Transport Internet access assumed Consideration of OSI Layer 6 protocols –HL7 over HTTP –HL7 over Email –HL7 Lower Level Protocol

11. HL7 over HTTP Advantages –HL7 standard acknowledgement possible –Ability to reject connections –Industry standard –Ease of interoperability for 3 rd parties –Connectionless scalable –URL & Headers available for protocol variations Eg. Http1.1 keep alive, content types Disadvantages –Need for full time internet presence

12. Provider Addressing Issues Australia 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

13. 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

14. HL7 Master Files Query

15. HL7 for Mere Mortals

16. 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

17. 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?

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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