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Oliver Frank wrote: I can see the dialogue now between the Medicare Australia auditors in the specialist's office, just like in the TV crime shows: "Yeah, this referral must have come from Andrew Patterson alright - it's got his fingerprints all over it." Oliver and List But seriously, biometrics would solve a lot of the concerns people have about losing their token, not having it with them, and also issues about generation of the key within the token. The hurdles one has to leap over to get an individual certificate now, and not to mention the renewing every 2 years, would make biometrics appealing to both doctors and gov't, I would have thought. The cost of issuing doctors with fingerprint readers would not be much different to the current issuing of tokens (perhaps a bit more but the lack of need of renewal could offset the increase). Although, based on the current attitude of gov't to medical IT we would have to buy our own. Also could be useful in surgeries to get away from the forgotten or unused password (or sticky note on the computer with password written on it). Also, I think we need to question the whole business structure (red tape restrictions) of gov't on clinical management. Why do we need the referral to have a signature on it that is proved to be me? Why can't we just notify Medicare we are referring a patient, or the specialist notify Medicare (or even on the pt claim form) that a referral has been made. Is it not up to the specialist to validate that they trust the letter I have sent them? Otherwise the information in it may be misleading and they should not rely on it. Why does the gov't need to be able to see the clinical note? Surely there are other business practices that are better than this archaic one in which we are working. Don't get me wrong, I still think the GP should be the gatekeeper to secondary care, but I think the system could be reworked on a big picture level. I would also like to see specialists being able to act as true consultants. It would help solve much of the workforce problems now if GPs could get paid for some time spent communicating with a consultant specialist and the specialist also getting paid for such communication. This communication could be in electronic format. This could allow time for reflection and further questioning (by secure e-mail or telephone or fax) and could even allow reviewing of digital images (such as for dermatology). Some indemnity issues would need to be worked through, but I think the efficiency gains to specialists and the community would be enormous and would also empower GPs to manage patients more themselves. Think how many less patients you would actually need to send to a dermatologist (usually a few months wait and rash is different or patient very annoyed) if they received a quality image on which they could comment. They might still need to see the patient but you could start a management plan prior. Convenience to the patient is enormous. Likewise with prescriptions. I agree with some other person's posting that we should be able to send an electronic prescription (signed by biometrics) to some holding bank/site and if not claimed by some (any) pharmacist acting for a patient, then it is discarded. Currently there are many prescriptions never filled by patients and quite a few of these are by agreement with the doctor ("If you don't improve within x days then get this prescription filled.") and it is also the right of a patient to decide not to take a particular treatment. Hence, there should not be a compulsion by some nervous pharmacist with an e-script to call the patient and ask them to collect the medication. Another annoyance is the need to provide prescriptions for patients in residential care under nursing supervision. Why can we not just have residents who are on long term medications reviewed by us (the doctor) every 2 or 3 or 4 or whatever months? Perhaps we just need to sign the drug chart to say we have reviewed it? Meanwhile, the pharmacist keeps dispensing based on the drug chart. We get paid for reviewing patient and medication chart (but please, no more EPC type paperwork!) and the pharmacist gets paid for supervising the medication dispensing. No prescription required! No spending hours on unproductive and unpaid tasks. Obviously legislation would need to be changed, but this is not beyond the realms of imagination or common sense. We need some big picture changes. They don't need to be as alarming as physios and chiropractors referring and by passing the GP but we should be able to change some fundamental blocks to productivity. "I have a dream". Rob Hosking Bacchus Marsh, Vic Andrew Patterson wrote: |
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