Medical Objects

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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
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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

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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

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Medical Objects Network Today
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Medical Objects

• So what is HL7?
• HL7 Health Level 7
• 7 application layer in OSI model
• Open standards based architecture
• Active HL7 RD program since 1999.
• HL7 USA member since 1999
• HL7 Australia member since inception
• Standards Australia Pathology Radiology
  Messaging committee member

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The pieces

• Data Acquisition / Systems Integration
• Transport
• Recipient/Provider Addressing
• Delivery Acknowledgment Protocols
• Security Authentication
• Routing
• Network topology
• Use of standards HL7

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Specialist report acquisition

• Specialist report creation
• Word Processor integration
• HL7 based custom reporting clients

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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

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GP Referral
Digital Signature Block
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Transport

• Internet access assumed
• Consideration of OSI Layer 6 protocols
• HL7 over HTTP
• HL7 over Email
• HL7 Lower Level Protocol

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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

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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

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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

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HL7 Master Files Query
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HL7 for Mere Mortals
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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

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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?

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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

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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

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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

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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

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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

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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

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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

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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_at_medical-objects.com.au
• Medical-Objects 61 7 5456 6000