Pathology and General Practice Software Integration Project (PaGSIP) (2003)
Description
This project sought to implement the electronic transfer of pathology orders from general practitioners (GPs), and pathology results back to GPs, using Health Level Seven (HL7) messaging standards and Public Key Infrastructure (PKI) security. The Commonwealth wanted these projects based on the “Australian Handbook on Pathology Messaging using HL7 Version 2.3.1” as published by Standards Australia.
demonstrate timesaving, effective and consistent transfer of pathology results
demonstrate an infrastructure and GP desktop processes that enable pathology data to be better handled by the GP
demonstrate improved accuracy of data capture, facilitate improved pathology workflow and increase accuracy of matching results to orders.
These aims and objectives were only partially achieved due to delays in getting the messaging system installed and working satisfactorily. This resulted in only one GP practice in Ballarat effectively sending and receiving pathology HL7 messages.
Findings
Code sets would play a useful part in further pathology orders/reports projects.
The ease of use of the process for ordering pathology tests, and the ability to track ordering of pathology tests, were advantages of this messaging system.
Delays in the installation process caused some unrest with GPs, however, once the trial commenced and the benefits of the system were demonstrated there was acceptance of the system.
Recommendations
The use of HL7 messaging capabilities HL7 2.3.1 should be encouraged within general practice pathology information system providers to facilitate further trials.
Incorporate the specified changes to the ‘Pathology Handbook’ as identified in this project.
Conduct a workshop for all pathology information systems providers and practice management providers to encourage them to develop HL7 message capabilities to HL7 2.3.1 as a minimum.
Conduct a second trial with a laboratory to receive electronic pathology requests and send electronic pathology results. Run the trial over an extended period of time to demonstrate the effectiveness of electronic messaging on practice and laboratory workflow and improved patient care.
Use pathology order codes in the ACT Health Information Network Pilot to streamline ordering pathology tests.
Implement and trial the use of atomised data to underpin electronic decision support in GP software.
Conduct costing of benefits of electronic request processing to pathology practices.
Key Project Learnings
Procedural issues were many and varied and ranged from those specifically related to the GP practice management software, the laboratory information system, PKI implementations and Argus software.
The process for obtaining HeSA/PKI location certificates should be streamlined.
A thorough risk analysis to examine the hardware and software infrastructure of the practice, and a complete review of current work practices, should have been implemented at the commencement of the project.
At least one GP should have participated in steering committee meetings.
There should have been closer involvement of Division information technology (IT) staff with Collaborative Centre for eHealth (CCeH) IT staff through the development and installation phases of the project.
There should have been a closer liaison with GP practice staff, Division IT staff and CCeH IT staff to determine the most efficient method of getting software installed, tested and working satisfactorily.
Working with general practice in future projects requires considerably more interaction with GPs and their practice staff. This involves complete involvement of practice staff in the project processes, including participation at steering committee level, thorough pre-trial analysis of all workflows, hardware and software configurations and software usage.
Access to GP practices is problematic due to their very specific times of low activity which were during lunch times and after hours. However, after hours access was difficult to negotiate due to security and confidentiality issues around patient data. This left lunch times as the main access opportunity which resulted in a longer than anticipated installation process.
Pathology laboratories receive hundreds of specimens daily for processing, and any installations must aim for minimal operational delays.
Ensure thorough and complete testing is carried out in a laboratory environment prior to installation at test sites. Once testing has been completed, sign off by the appropriate stakeholders is required.
Implementation of software in future trials needs rigorous testing so that once installed it is operating correctly and risks of software failure are minimised. This is to ensure minimal impact on practice/laboratory workflows and maximum opportunity to achieve stated project outcomes.
The original project timeframe of six months was too short to achieve the required outcomes. The process of getting all parties to produce the necessary components of the project was more complicated and lengthy than originally estimated. A 12 month timeframe would have given adequate time to engage all stakeholders and have all software working correctly. It would have also given a longer time to run the trial and hence more weight to the evaluation process.
The trial size and period did not yield large numbers of pathology results and requests being transmitted. This meant the statistical breakdown did not yield sufficient numbers to be useful.
Follow on Initiatives and Projects
Integration of relevant elements into National Pathology Accreditation Advisory Council (NPAAC) requirements and guidelines.
