Secure medical communication started in Australia in the mid-nineties with simple home spun solutions. Since then a number of companies have developed secure communication as a service to medical practitioners. Over the ensuing years some of the early providers have disappeared and there has been consolidation in the market.
The current providers’ systems are incompatible with each other, making it frustrating for end users who complain it is like being on Optus but not being able to call Telstra phones. While it is feasible to bridge data from one provider to another, it is never in an individual company’s interest to enable this.
The fear is losing customers to a rival or worse incurring the technology costs while the rival reaps the income. Discussions aimed at progressing a solution have been ongoing for years but the business problem has yet to be solved.
As with all communication technologies the bigger the provider’s pool of customers the greater the value to any individual customer. This is described as the “network effect” and Metcalfe’s Law shows that for large values of n the value of the system is roughly equivalent to the square of the number of nodes [n(n-1)/2].. To put it in more concrete terms, “Everybody is on FaceBook because everybody is on FaceBook”.
The task for any individual platform is to get as big as possible as fast as possible. This may entail making losses in the early stages of the company. The history of technology is littered with examples from the early telephone companies, to videotape formats and to countless startups in the age of the Internet.
As a current day example Uber wants to own the ride sharing business. It has never made a profit and loses about a billion dollars per year. It has recently been valued at $120 billion. Shareholders are invested for the long term.
Healthlink is one of the major players in medical communication in Australia. Its business model has been to provide free services to general practitioners and generate revenue from paying specialists and diagnostic services. It has also partnered with NSW Roads and Maritime Services to streamline the lodging of routine Driver's License medical examinations (as previously reported in GPSpeak). It is used in the Northern Rivers by Pathology North for sending their reports.
Their network has been growing steadily over the last five years and has reached a critical mass at least for GP to GP communication. Setup guides for all the common GP electronic health records are available and once the EHR address book has been configured for an individual recipient sending a secure document it is as simple as clicking a button.
Data is transferred at the practice level where it is handled and sorted by the practice’s EHR. Users working at different practices will receive their correspondence at the correct site if this has been selected in the addressee box and configured correctly in the sender’s system.
The online directory makes it possible to easily find the Healthlink practice address code for any particular user. Getting started is therefore a simple task.
In some EHRs, for example Best Practice, Healhlink users are identified by a gold star. This acts as a reminder to click the “Outbox” as well as print a copy of the letter for the patient. Transmission of the document occurs asynchronously but usually within 30 minutes and adds only seconds to the consultation length.
Unlike some other solutions, Healthlink’s system retains the original formatting, which is appreciated by recipients.
Healthlink has hit the sweet spot for GP to “other” communication. It has a large number of users, is easy for the technical staff to configure, easy for practice staff to manage and update and, most importantly of all, simple for GPs to use.
An excel spreadsheet with the addresses and Healthlink practice identifiers of all North Coast practices is available on the GPSpeak website and has also been uploaded to the Nordocs Facebook group.
There are currently 147 practices registered with Healthlink and the file provides the code that is required by the sender’s electronic health record. Updating the address book is a simple task and can be delegated to practice staff.
Practices that wish to register for Healthlink will need their identifiers from Medicare (via Proda, the Provider Digital Access portal), the National Authentication Service for Health (NASH) and the Australian Health Practitioner Regulation Agency (AHPRA). Completing the online Service Application Form ensures that all the required information has been collected and can then be submitted by mail.