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IMPLEMENTING ELECTRONIC MESSAGING FOR GENERAL PRACTITIONER OUT OF HOURS CO-OPS: 

IMPLEMENTING ELECTRONIC MESSAGING FOR GENERAL PRACTITIONER OUT OF HOURS CO-OPS F Murray, P McCarron, M Kearns, J Carton, P Jefferies, R Hahn, B O'Mahony HSE South Eastern Area, Kilkenny; CareDoc Out of Hours Co-operative, Carlow; Adastra Software Ltd

Overview: 

Overview Describe the CareDoc GP Out of Hours Co-operative; Explain electronic messaging of Co-op report and acknowledgement; Describe the hardware, software and communications in use; Outline the Standards in use; Explain data protection, security and confidentiality issues; List the partners working on this project

CareDoc GP Co-op: 

CareDoc GP Co-op Carlow Emergency Doctors on Call Limited (CareDoc) joint venture between local family doctors, HSE SE and Dept. of Health & Children Provides out of hours GP services to 500,000 people in Counties Carlow, Kilkenny, South Tipperary, Waterford, Wexford and Wicklow; Has 276 GP members; GP care provided after 6.00pm each evening and all day on weekends and bank holidays; Typical call handling process All calls & notes recorded on Adastra IT system

CareDoc Communications: 

CareDoc Communications After a bank holiday weekend, 3,000 reports on patient contacts faxed to 143 GP surgeries; 3 fax servers in operation from early morning to late afternoon every working day;

The Messaging Vision: 

The Messaging Vision Move from fax to electronic message; Work with the HSE message standard; Use Web services; Practice connects to a message broker each morning, downloads Co-op reports and uploads acknowledgements; Report displayed within GP practice software; Report integrates directly into each patient’s electronic record;

Electronic Co-op message: 

Electronic Co-op message Faster; Configurable display within practice software; Integrates into individual patient record; Acknowledgement closes the loop;

Message Exchange: 

Message Exchange

Standards in use: 

Standards in use HL7 (Health Level Seven) version 2.4 with XML (Extensible Markup Language) encoding; HSE Referral Discharge Message Standard; HSE Acknowledgement Message Standard; Web Services: SOAP, WSDL (Web Services Descriptive Language);

HL7XML messages: 

HL7XML messages

Hardware & Software: 

Hardware & Software Dell server Red Hat Linux OS Apache Web server MySQL database PHP hyper text processor NuSOAP Web service API

Data Protection: 

Data Protection CareDoc is the data controller; HSE SE is the data processor: Data Protection agreement in place between CareDoc and HSE; Agreement complies with all applicable data protection laws and regulations; All GP practices registered with data protection commissioner;

Security: 

Security GP practices connect to HSE SE network over RAS with user name, password and caller ID; Practice software Web services client authenticates with Web services broker using username, password and challenge/response to shared security key; Session ID controls duration of communications session; Acknowledgement message is parsed by broker to ensure XML is acceptable and can be routed;

Privacy & Confidentiality: 

Privacy & Confidentiality Web services broker only passes messages between CareDoc and GPs; Messages are deleted from broker once they are delivered; No long term storage of messages on the broker; GP practices only have access to their own messages; Messages can be displayed by individual GP within the practice;

Where are we now?: 

Where are we now? Pilot phase with target of 20 practices continues to end of 2005; Currently 6 practices using the service, and receiving both electronic and faxed reports; All practices audit reports for at least 4 weeks and sign-off, before faxing ceases; 413 co-op messages transmitted in the last 3 weeks;

Why is this important at a Service Level?: 

Why is this important at a Service Level? Provides improved communications between day time and out of hours services for GPs and patients; Promotes seamless patient care between services; Supports the electronic patient record in primary care; Has the potential to be implemented nationally;

Why is this important at a Technical Level?: 

Why is this important at a Technical Level? Adastra co-op information system in use nationally; Adastra can now output to the HSE HL7XML message standard; Open standards used; Web services used successfully; Code for Web services broker available to anyone who wishes to use it; First implementation of two way messaging in primary care

Project Partners: 

Project Partners CareDoc HSE South Eastern Area Adastra Software Health Ireland Partners (Health One) Medicom (Dynamic©GP) JacSoftware (GP Mac)

Thank you: 

Thank you Happy to take questions or comments Emails to Fergus.Murray@maila.hse.ie