End-to-end web-based bi-directional referrals connecting primary care to specialists in real time is a big piece of improved interoperability, and likely a major worry for the business model of secure messaging vendors.
The announcement this week that Consultmed had completed work to integrate with the major cloud-based specialist patient management system Gentu, owned and run by Magentus, must have landed with a significant thud in the head offices of our major secure messaging providers.
The idea that you can now securely bi-directionally communicate in real time between a specialist and a GP via the web, and include the patient in that conversation to co-ordinate things like the specialist appointment and advice, has huge implications for system-wide interoperability.
Now all those specialists working in hospitals that use Gentu have a much better way to talk to GPs and those GPs’ patients. And some hospitals around the country are now adopting the technology directly as a means of connecting to their local GP and community care providers, and through this, dropping the use of secure messaging to communicate.
Secure messaging systems are one-directional and tied to older server-bound patient management systems – all of which will need to re-architect for web-based communication under the government’s “sharing by default” plans. And if a specialist wants to confirm anything back to a GP, or a patient, they have to go into their system and use a different path to get there.
Secure messaging is clunky. In the nexus between a GP and a specialist the message has to be fairly simple and highly formatted, and in a lot of cases the message simply isn’t seen at either end for one reason or another.
Some estimates of hospital referrals using securing messaging have the GP end locally not actually seeing the message (it’s usually sent, just hard to get at or the GP isn’t properly alerted) up to 30% to 40% of the time. It works much better than this of course in quite a few regions, but web-based protocols look cheaper, more flexible and reasonably easy to implement.
Consultmed isn’t exactly a secure messaging killer app, but it’s one part of a suite of new web and FHIR-based technologies that together are going to significantly threaten the old world with much faster, more visible and flexible direct communications between specialists, hospitals, GPs and other community-based care organisations, such as mental health groups, aged care and palliative care organisations.
In a straight-up comparison of flexibility, communication effectiveness and patient convenience, Consultmed’s offering now feels like it’s a no-brainer for those specialists who are already using Gentu. According to Magentus that’s around 2000 specialist practices which might covert to up to 10,000 specialists around the country.
In a secure messaging exchange on a specialist referral, the GP usually isn’t in the loop as to whether the specialist got the referral and what happens even if they did. They need to rely on the specialist to get back via a different path if there is anything wrong.
Then the GP usually has to print out a paper letter, give it to the patient – who will often lose it (I always do) – and rely on the patient to separately find the specialist, ring them and set up the appointment.
Using Consultmed, the referral is sent via the web PMS-to-PMS, and the patient (if they have the app) so the patient is looped in, and allows for the patient to directly make an appointment based on the referral.
The specialist is able to talk to the patient directly as well. All around there is a lot more easy and sensible communication going on.
Outside of this, the communication for both the GP and specialist is simpler to view and it’s bi-directional so either side can clarify things in real time. No reaching into the system to search for today’s referrals and then waiting around to see if the patient ever even rings or turns up and then trying to match paperwork.
Past this, the Consultmed offering is much more capable in communication terms than just managing a digital referral.
It also has functionality for clinical advice and guidance (which will usually be from the specialist back to the GP around how to manage the patient post a consult and adds a whole new dimension to the patient’s management above the specialist letter), digital forms, reports and consents, and even, virtual triage.
In terms of efficiency and flexibility for the GP and specialist at either end, Consultmed is also applying AI to all the documentation processes to simplify document handling and automate paperwork flows.
All stuff that is not easy to apply to the secure messaging process because it’s so rigid and formatted.
Of course, the death of secure messaging has been foretold many times before (we’ve done it a few times over the years and been found out).
Each time not too much changed in the volume of how much these networks handle between GPs, specialists and, most importantly probably, private pathology.
Even if Consultmed catches fire, the secure messaging networks aren’t going to fold any time soon because for web-based replacement communication protocols to usurp these networks, every GP, specialist, hospital and allied health and community health provider will need to have in place a form of patient management system that is either web-architected, or has middleware, such as Halo Connect, which allows these groups to talk easily via the web.
But there is plenty of reason to think that the process of transformation from the old server-bound technology to the new web-based communication protocols is now at the early stages of getting a lot of traction and, depending, in particular, on how quickly hospital CIOs can get their heads around the advantages of this technology, things might go very quickly from here.
Related
Also, the government wants it all to happen quickly now, so much so that they have introduced legislation that is laying the groundwork to be able to dictate to all providers and the software platform vendors that “the web shall be the way” in the not-too-distant future.
So far, this legislation is demanding that the private pathology providers upload patient results to the My Health Record in near real time. They can only do this via web-based protocols, and once they all develop these, they will be able to talk to the major GP and specialist patient management systems using the same protocols – Sonic already does this with Gentu.
Worryingly for the secure messaging vendors, Consultmed, which is already integrated fully with our two major GP PMS systems, BP and Medical Director, is starting to get very interesting traction with hospitals wanting to upgrade not just their referral pathways to GPs and the community but ways and means of connecting more efficiently with the outside world for other hospital-related services.
Consultmed has major contracts with the Alfred group in Melbourne, and the Sydney Children’s Hospital Network, South West Sydney and Murrumbidgee LHDs in NSW for its web-based referral system, with each hospital group looking to significantly improve its interoperability with local specialists and GPs.
The integration with Gentu, which is the major specialist PMS, is a big step because now hospitals, specialists and GPs can be connected for all the communication protocols that Consultmed is developing.
Consultmed also has contracts with all NSW PHNs and some others around the country to create a web-based referral connection between GPs and the federal government’s major mental health initiative, Head to Health. This is the first time GPs can easily talk directly to their local Head to Health centres with referrals and appointments.
Of course, the major business of all the secure messaging providers remains messaging on tests for GPs and specialists with the major private pathology laboratories.
But even this major income stream now appears to have significant cracks starting to open in it.
Recently Magentus announced that it had integrated directly from its cloud-based Gentu product to Sonic, which means that these two systems will be able to talk directly via web protocols to share communication on test ordering more efficiently.
It feels inevitable that both major GP PMS vendors will do the same thing in the near term as their progress on upgrading their installed base of users to web enabled protocols progresses.
Although there are a lot of private pathology providers out there, there are really only three big ones that matter and make up most of the market, and Sonic has already developed its integration.
In the case of our largest GP PMS vendor, Best Practice, it is deeply embedded with the Halo Connect project (it’s a major shareholder) , which is an FHIR-based middleware solution that will allow older server-bound installations of BP to talk externally and through all its integrations via the web.
Magentus is focusing heavily on converting all its older server-bound Genie installations to the web-based Gentu. The process looked like it was going to be much harder for the GP PMS vendors until the likes of Halo Connect came along and provided a “connector” service so a lot of BP server installations won’t have to convert to a fully web-architected version of the software.
Medical Director is working on the same thing with its web-based Helix version of the software.
Currently BP is busy convincing all its existing integration partners to go to the trouble of building an integration to Halo Connect. This is all in preparation for BP being able to do stuff like create direct web-based connections to the major pathology labs and to meet the government’s near-term demand that they be able to share patient data far more seamlessly in real time via the web.
If the secure messaging providers still aren’t worried by this activity, the fact that BP now has a pilot that is aiming to test a direct integration between one of our two biggest enterprise EMRs, Oracle (Cerner), and their GP platform, should indicate that web-based interoperability between the major provider nodes of our healthcare system is slowly but surely coming to an EMR or PMS near you.
With all these dynamics seemingly in play now, can we now finally see the actual beginning of the end of the old secure messaging network in this country?
While secure messaging still isn’t ending any time soon, you can definitely see for the first time the actual mechanics of the existential threat that the web has been for the business model of these vendors for a long time now, and, tellingly, now we are all witnessing the practical working implementations of that technology.
And it looks to be easier than a lot of people thought it might be.