QHR, Telus set to create national messaging standards

By Rosie Lombardi

Dr Michael GuerriereA Canada-wide communications system is being developed that will allow doctors to send secure messages to each other from their EMRs. QHR Technologies and Telus Health recently announced they’re collaborating on a project that will merge the two companies’ protocols to create one national communications standard that any healthcare entity can use, and they’re inviting other EMR vendors to join the project. “I think we’ll have the connections in place by early 2017,” says Dr. Michael Guerriere (pictured), CMO at Telus Health. “Almost half of Canadian doctors are either Telus or QHR users, so we’re reaching the tipping point where doctors will see the value of adopting using our communications standard.”

From a technology standpoint, creating a unified standard from Telus and QHR’s existing communications standards will not be difficult, says Guerriere.  QHR’s doctor-users can already message each other, as can many of Telus’ users, he says. “We haven’t got all of our EMR platforms on one standard yet, but PS Suite users can message other PS Suite users.”

But most doctors don’t use these existing messaging capabilities because the number of users in each platform is small. “If a doctor you’re trying to communicate with isn’t on QHR or whatever platform you use, then it doesn’t work. You don’t want to use a fax machine if you can only communicate with 20 percent of the people you might want to contact. You need to be able to communicate with the majority of other professionals in order to see the adoption really pick up. That’s why building a national system is so important to improve communications.”

The more challenging component of the project will be creating a common directory that will allow messages to cross all the different platforms. “The directory is what will allow doctors to find the right person to message, so we need a system for properly managing our doctors’ identities. It will need to have strong security, and have the ability to audit message trails.”

Telus already has robust cross-platform identity management mechanisms in place, he adds. “Telus manages claims electronically for insurance companies and allied health professionals, and for governments around medications. What’s new is that we will be extending it to EMR environments for the new system.”

Guerriere emphasizes that this merged messaging system will not be a glorified e-mail system, but will have a powerful new feature: it will allow messaging directly from the EMR. “If I send a message to another doctor about a specific patient, I’ll be sending that message from within the patient’s chart. That message automatically becomes part of the chart. That’s why it’s very different from email. We’re integrating this right into the patient chart so that’s where the message is sent and received, and it all becomes part of that patient’s record.”

Once in place, the system will make communications between doctors much easier. E-referrals are an obvious area where messaging can make communication more efficient. “Not only can you message e-referrals, you can also ask clinical questions to clarify some element, and the back and forth will all automatically become part of the medical record.”

A national messaging system would also open the door to new areas of communication, for example, around medication management. “A specialist may see a patient and change their meds, but there’s no electronic mechanism today to allow that specialist to communicate that to the family doctor.  This would also be very useful if a doctor discontinues medication that was ordered by a different doctor. Ideally, you’d want that information not only to go to the pharmacy but also to the doctor who ordered the medication in the first place. Those kinds of communications today are just not happening, which creates a lot of confusion.”

There are already many integration projects afoot in most provinces for e-referrals and to allow hospitals and doctors to communicate. QHR and Telus’ merged messaging system may eliminate the need for some of these projects. “Initially our messages will be unstructured free text but then we’ll use the same distribution system to develop and move more structured messages, like requisitions for tests or electronic prescriptions. Then you could attach documents from the chart to those messages so you could send X-rays and lab results. You could send a lot of different things which would really enrich the doctor’s ability to communicate and eliminate all the faxes and papers that are used today.”

However, there are some areas where other messaging protocols are more appropriate, for example, uploading and downloading data. “For instance, if a doctor wants to get lab reports from the hospital, you could use a messaging protocol like ours but I think sometimes using an HL-7 protocol would be more effective for communications that are not doctor to doctor.”

Guerriere says Nightingale, Oscar and other EMR vendors are welcome to participate in developing a new national standard that will include their users. “If we can demonstrate significant benefits result from better collaboration between those doctors in areas where Telus and QHR reach, say, 70 or 80 percent of doctors, I believe it’ll inspire other vendors to work with us. We’re also actively exploring how to connect to other healthcare entities like pharmacies and allied health. We think that the potential for collaboration across the healthcare spectrum is an enormous opportunity.”