It seems there are lots of different ways to format a letter type message in Australian Health IT
- Pretend its a path report and use ORU with the appropriate LOINC code. This seems the most common
- Do it “properly”: use REF
- Use PIT, still around I understand
- MyEHR CDA type
And within that
- 1/ use the FT plain-text format
- 2/ embed as an RTF document
- 3/ embed as PDF
So that’s 12 permutations at least and I’m sure I’m missing some. Which options have the best chance of getting parsed/rendered correctly by the current crop of GP software (MDW, Best Practice, Zedmed, etc)
Well, I think that right now there is no great answer to this question. I consulted Peter Young from Telstra Health, who is leading a vendor consortium that is working with Australian Digital Health Agency (ADHA) on this particular issue. Peter says:
There is work underway in collaboration between HL7 Australia, ADHA and a number of industry players to create a standard mechanism of sharing messages between clinical applications and capable of being transmitted via SMD based on an HL7 Ref I12. It leverages the recently published pathology messaging profile and is part of a broader program led by ADHA to improve interoperability between applications. Initially there is a baseline specification that provides essential structured data with a clinical document that can be in either of RTF, pdf, html or text. The idea is that receiving applications will support any document format; if not natively, at least use a viewer. The work plan also includes extensions to add more structured data. Most of the major clinical and messaging vendors are involved in the work program.
The link to the simplified profile is https://confluence.hl7australia.com/display/OO/Appendix+8+Simplified+REF+profile
I think that the best bet right now is the REF I12 message, with PDF for the letter. But this is an area of active work.