All GP practices in the trial use the popular Medical Director (MD) system and this could be a possible target for IT integration if it is to be done at the medical practice level. MD version MD/PS3.12.1.b (researched in January 2012) supports the standard Health Identifiers for patients and health care providers. MD also uses the MDExchange system for secure communication of medical reports. One option would be to integrate the creation of our report into MD; the other option would be access MD data locally.
However, IT integration at the GP practice level is not the only possibility. It would also be possible to integrate the IT systems at the pathology laboratory level, generating the enhanced reports instead of or as well as the more traditional reports and communicating them to medical practices (and eventually the PCEHR database) in the same way. Again this could be done as an integrated solution or as an add-on / stand-alone application at the laboratory site.
A final option would be a remote stand-alone application, which receives its data via HL7 and maintains its own patient database.
The exact strategy for IT integration currently is under consideration and depends in part on the vendors of the various IT systems used in medical practices and pathology laboratories. However, the widespread use of HL7 2.x standards will certainly make IT integration easier, whatever strategy is used. It means that generation of our enhanced reports can be more loosely coupled from other aspects of the IT system, easing separate development of our reports and interfacing with multiple other IT systems.
The computational storage and bandwidth requirements of this project are quite modest and would not place excessive demands on IT infrastructures.
Table 13 shows a comparison of possible installation locations. At this stage the remote stand-alone application looks the most promising. For details on the different criteria see below.
Table 13: Installation location and criteria matrix
 | Patient data | Report data | History | Diversity | Re-usability | Research data | Installation Maintenance | Independence | Cost |
|---|---|---|---|---|---|---|---|---|---|
| Integrated into GP’s PMS
(-3) | + | 0 | 0 | - | - | 0 | - | - | - |
| Stand-alone app on GP’s system
(+1) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | + | + |
| Integrated into Pathology LMS
(-4) | - | + | 0 | - | - | 0 | - | - | - |
| Stand-alone on Lab’s system
(-2) | - | 0 | 0 | 0 | 0 | 0 | - | + | 0 |
| Remote stand-alone application
(+4) | - | 0 | 0 | + | + | + | + | + | + |