All the recent dialogue about EDIFACT has, IMHO, only added weight to
my 500 pound gorilla theory about EDI that I began to develop in the
early days of the Networking project. Let me explain:
In almost all areas, both commerce and in UK healthcare, where EDI has
been successfully implemented, there has been a "500 pound gorilla" at
one end of the transaction who essentially dictated the terms. If the
gorilla says jump, everyone else jumps. Look at the major
supermarkets or the airline ticketing/booking arena - the impetus for
EDI was established because either one or a very small number of
gorillas decided that's how it was going to be, so everyone else
jumped.
In UK healthcare, there has been one shining example of effective and
efficient EDI - dental claims to the DPB in Eastbourne. The DPB = 500
pound gorilla. They identified major savings in their operational
costs if dentists communicated electronically and then just dictated
the terms with dentists and their system suppliers. No messing about,
and it worked.
The only other UK healthcare EDI messages that have got anywhere at
any reasonable pace and had reasonable implementation success have
been the GP to FHSA (sorry - HA) ones. With one single target at the
FHSA end (all 98 have the same system - the Exeter system), the FHSCU
dictated the terms essentially - OK perhaps not a 500 pound gorilla.
So the corollary of my theory - Where there is no gorilla, progress
will always be painfully slow and indeed agreement and practical
implementation may never actually get reached. It's a many to many
situation - for example with GP referrals or Pathology results -
there's umpteen GP systems out there at one end and upteen hospital
systems at the other. Of course there will be plenty of theorising
and lots of input on requirements. But without the one gorilla at one
end you'll end up with a message that's all things for all persons
(and you'll likely therefore end up with something that's no practical
use for anyone). And there's a risk it ends up being nothing more than
an expensive academic exercise.
Unfortunately I don't know of any candidates for the gorilla job in
the GP/Hospital messaging area. Regions have gone and the DoH/NHS
Exec's ability to say jump in this area has gone. Interestingly the GP
and hospital system suppliers at both ends have only ever been
lukewarm about messaging, from what I've seen - yet it's essential the
suppliers are enthusiastic because they're the ones who have to
implement it and build the migration pathways from existing systems.
My prediction for 1997 - watch for hospital system suppliers extending
their systems into GP practices and starting to compete with GP
systems for provision of functionality in the practice. Attuned
Trusts will see this as a value added service to GPs that allows them
to compete for GP business against other Trusts. What will allow them
to do that ? - Web technologies. In theory we might even see GP
system suppliers extending their functionality into hospitals in a
similar way, but I suspect they haven't the clout to do it. And SGML?
Lots of interesting academic discussions continuing, but not taken up
enthusistically by suppliers who instead make do with HTML and Web
technologies because they are "Good enough at the right price", and
allow easy cost effective migration from and integration with the
current systems - at the end of the day that's the name of the game
for suppliers.
.....but then again I may be wrong.
---
Rob Tweed
IM&T Consulting Ltd; Health Web Services Ltd;
M/Gateway Developments Ltd
http://www.hwsl.co.uk/mgw
Tel: (+44) 181 540 1325
Fax: (+44) 181 715 4337
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