Secure messaging – the problem
Reliable, secure provider-to-provider communication is a key component of digitally enabled integrated and coordinated care across the Australian health sector. Secure messaging is a core foundational capability required to enable interoperability and safe, seamless, secure, and confidential information sharing across all healthcare providers and consumers.
While there are significant pockets of secure messaging in use, for example, supporting pathology communications and discharge summaries from certain hospitals, there continues to be the lack of a consistent approach to secure messaging and information exchange across Australian healthcare. This has led to significant challenges across the sector.
Secure Messaging Program
The Agency's current Secure Messaging Program aims to work collaboratively with industry and suppliers of secure messaging solutions and clinical software to reduce existing barriers to adoption and provide implementable solutions. Several key areas have been identified as barriers for implementation and form the core of the immediate technical work program:
- Simplifying the message structure and supporting several different content formats;
- Assessing the use of commercial security certificates;
- Assessing the use of propriety provider identifiers; and
- Improving access to reliable provider address information.
The Agency has established a Technical Working Group, with members from industry, to co-design solutions going forward.
Early proof of concept implementation projects are being established to validate the solution approach and scalability. The initial implementation projects will be underpinned by scenarios that cover:
- Discharge summaries from hospital to general practitioners or other providers;
- Referrals from general practitioners to specialists and / or allied health; and
- Reports from allied health to general practitioners, specialists or other providers.
In parallel with early co-development and implementation activity, the program will develop a future digital communication strategy and roadmap to support the needs of Australia’s healthcare system going forward.
The program is led by Bettina McMahon, Executive General Manager, Government and Industry Collaboration at the Agency, who is responsible for driving industry adoption and usability of digital health. There are three lead program sponsors: Dr Nathan Pinskier, who is a GP in Melbourne and Chair of the RACGP Expert Committee eHealth & Practice Systems; Dr Zoran Bolevich who is the Chief Executive for eHealth NSW; and Ms Fiona Panagoulias, who is a strong advocate for consumers and carers.
Please send your questions, comments, suggestions and ideas about this problem and this project to the Secure Messaging Program Manager, [email protected].
Secure Message Delivery (SMD) is a set of specifications that were developed collaboratively by the digital health community including NEHTA (which transitioned to the Australian Digital Health Agency from 1 July 2016), Standards Australia, desktop software vendors and secure messaging service providers. This set of specifications defines an approach to digital health communication using widely supported IT industry standards.
The SMD specifications support the secure delivery of messages containing clinical documents and/or other information between healthcare organisations, either directly or through one or more messaging service providers. A typical example is shown in the diagram below.
Historically, only healthcare organisations using the same secure messaging provider have been able to exchange messages securely. Secure messaging providers are working on connecting their networks using SMD and are expected to complete this in the first half of 2014. You can check the register of SMD compliant products here, or your messaging service provider can advise you of progress.
In addition to having a secure messaging connection, sending and receiving clinical systems need to be conformant to message format standards. The Agency has defined Clinical Document Architecture (CDA) standards for eReferrals, Specialist Letters and Discharge Summaries. This allows the exchange of these document types using secure messaging. Over time, the Agency and other bodies may define conformance assessment processes for additional document types.
If your clinical system product does not support SMD-based secure messaging and CDA document formats, check with your supplier for their plans to support these initiatives.
The benefits of Secure Message Delivery to providers may include:
- Secure exchange of clinical information and documents such as eReferrals and Discharge Summaries, preventing unauthorised interception of the message content.
- Reduced use of paper correspondence - less time chasing clinical information and investigations, resending or chasing referrals, scanning, printing, filing and posting.
- Confidential patient correspondence only seen by treating clinicians (no scanning necessary).
- System notification of successful message delivery, so that sending organisations know that a message has been received and decrypted by the intended receiving organisation.
- Potential to improve the timeliness of receipt of clinical information, and therefore the quality of care provided.
- Over time as software vendors enhance their digital health functionality, patient data contained in CDA documents, such as pathology results, will be able to be imported directly into the relevant fields in your patient's record. This will help consolidate the information in your clinical software rather than you needing to click into separate tabs to find scans and reports.