Outages and system availability is a major concern for stakeholders in relation to the Healthcare Identifiers infrastructure. The current SLA of 99.5% availability (unscheduled downtime only) is low compared with the availability levels required for systems used at the point of clinical care such as electronic medical records, patient administration and imaging systems where 99.9% is common. An SLA of 99.5% availability equates to 43.8 hours of downtime per annum compared to 8.8 hours at 99.9%. As adoption increases in parallel with wider implementation of the PCEHR system and Secure Messaging Delivery, availability at a level that matches the clinical systems using the Service will be critical. The notification processes and responsibilities for maintenance and release related outages need to be improved so that users can prepare appropriately for the period of the outage, and for any functional changes (in the case of new releases) that may need to be communicated to users. In the event of any outage, information should be provided on what the issue is and the expected down time provided to stakeholders as early as possible and updated if the situation changes. NEHTA is responsible for communication with stakeholders but unless this information is provided by DHS and communicated to the users in a timely fashion, it impacts the level of confidence needed to promote uptake of the system.
A change request is being processed to provide dedicated failover capabilities for the HI Service. There will be a risk of ongoing outages if this is not approved and funded.
Accurate demand planning is critical to ensure that DHS can predict and plan for the load on the system. Performance parameters need to be constantly monitored to make sure that they are appropriate, given the requirements of other systems integrating with the HI Service.
There have been recent issues with the vendor test environments. These were set up for testing of Healthcare Identifiers by vendors but their use has expanded to the PCEHR system and other purposes and they were not designed for this level of demand. A review of the test environment strategy based on the emerging requirements should be conducted to assess the full range of test requirements and users, and the infrastructure required to support this expanding role.
It should be noted that use of the HI Service is still very limited and at this point the system, support structures and infrastructure have not been tested with significant volumes. Regular review of performance as demand increases and effective processes to manage any emerging issues need to be in place.