RE: [GPCG_TALK] Details of Public Coag Outcome

[David de Bhál]

Andrew   It is so difficult to imagine that we are in competition with Medical Director.   Simply put, Virtual Practice is a web service which has all the attributes of the GEHR. Our focus is entirely different – the patient rather than an advertiser. We have developed a web based clinical care management system without the necessity for complex and expensive hardware but just simply a web browser.   We set out to design and implement a comprehensive medical record using the web and web services as a way to make this available to the patient, to the practitioner and to anybody else to whom the patient gave permission to view the record. Technology has been slowly becoming more widely available in order to catch up with our dream of an integrated patient focused care record more than six years ago but it has become increasingly available of late.   We are not solely focused on medical practitioners and our current Australian targets are Residential Aged Care Facilities who are largely ignored and not well serviced in terms of a combined nursing and medical record centered on the need to plan the care for those who seem to most need it. Our users are specialists, generalists, nursing staff, administrative staff, physiotherapists, diversional therapists, pharmacists all of whom can contribute to a longitudinal record with differing levels of access.    We have a single database for all information – management and clinical as well as an integral tasking, messaging, automated alerts and reminders. We have handover modules which aggregate information in particular areas over particular periods so that the continuity of care is maintained, automated advice to pharmacists of changes in prescriptions and drug dosages, batching of prescriptions, single click drug repeats with drug update checking, and a myriad of other services to various professionals involved in the care of the patient. Pharmacists, for example, can log on and see the actual prescription written by the doctor while there is no need for the doctor to sign the drug administration sheet which is generated directly from the doctors’ having written a prescription. Messaging allows the doctor to generate repeat prescriptions at their convenience. Bureaucratic tedium is minimized. A CMA can be done in less than ten minutes from the input of all members of the team.   There is a minimal amount of typing involved with various ways of collecting highly complex information of the highest quality in a way we were taught to collect it which can then be analysed and queried as required. We comply with all the OpenEHR/GEHR requirements and we are HL7 compliant.   The only requirement for using Virtual Practice is an ability to use a computer to play solitaire. Our computer-illiterate grannies learn to use it very easily and in the shortest time find that they enjoy it. When they wish to transfer a patient they call up a transfer document which leads them through the appropriate list of forms to be checked and then emailed, faxed or just printed from the desktop with one click depending on where they are being transferred.   Our support systems are unparalled and we can log on and view problems which clients are having and help them in real time.   All of this is done on open source platform with the exception of the use of IE 5.5 or greater [because of its superior abilities to handle the xml data islands], in a secure environment with SSL 128 bit encryption. It is available to any authorized person at any time and at any place they can connect to the web. Backups and maintenance are automated, there is no necessity for elaborated local servers as no information regarding the patient is held by the user. We charge on a transactional basis and all costs are born by the users. We have no advertising. A full integral billing module allows the various users to generate their own fees as they see fit independent of the record. There are links on every page to various items of decision support.     I have had limited use of Medical Director I must admit but I have found it increasingly difficult to figure out whether it is an electronic record with advertising or advertising with electronic records. It is largely counterintuitive and difficult to use. Patients have repeatedly wondered what has happened to primary care in that they now find doctors struggling with software rather than with them. My limited experience with Medical Director always as a locum or part-timer and not as the primary user of it has been that medical records have gone from an illegible scrawl to virtually non existent. My specialist colleagues complain that the drug records are usually out of date and that the information is largely irrelevant. You will have heard specialists at the AMA talkfest in Canberra criticize the letters they receive. Specialists seem reluctant to embrace your model.   I accept that you will tell me that it is used by the greatest proportion of doctors and practices etc. That is because they have had little other competition and rely on PIP which loosely insists on electronic prescribing as a condition. You will remember that HCN was started with public monies and supported by drug advertisers at minimal initial cost to users in an environment where the regulators had a different view of the EHR and different expectations but you will also accept that doctors are creatures of habit and old and bad habits die hard. Your marketing has been very effective   This weeks Australian Doctor is far from complimentary about the use to which it is being put by Primary Health Care Centres. It is also a puzzle to me how doctors are unable to accept any gratuities of greater value than $10 from drug representatives but are allowed to accept what amounts to a subsidy of $2000 “worth” of software in the form of advertising from Medical Director.   Additionally, you and some of your former staff have indicated your views that Health Connect and the centralized summaries are very very distant and impossible to implement. You might be surprised just how close it might be.   I am not permitted to share with you a DOHA Case Study which is at present under Ministerial Embargo but a quote from it  “Virtual Practice is a user friendly comprehensive medical record management system that saves us time and energy. It allows staff to document all levels of care appropriately and accurately in half the time, maximising the potential for Government funding.”     So all these features that are not a part of Medical Director are those that make it the GREATEST  impediment to “their implementation” viz “ the secure distributed electronic health record”.   More realistically it might be like comparing a Segway with a tricycle. I find the tricycle impossible but a Segway has opened up enormous areas to me that were impossible previously.   I did not want to embrace on a criticism of Medical Director but it may well be time to accept that it is a legacy system and that it has not a great contribution to make to “the secure distrubted HER”     From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Andrew Magennis Sent: Saturday, February 11, 2006 5:39 PM To: General Practice Computing Group Talk Subject: Re: [GPCG_TALK] Details of Public Coag Outcome   David Thankyou for your constructive input as always. I would be interested to hear why you believe this to be so, other than that you are a competitor to our product. Andrew   Dr. Andrew Magennis M.B.,B.S. B.Sc (Hons) Dip. R.A.C.O.G. Medical Director Health Communication Network   Contact Work Tel: 03 9810 4510 Work Fax: 03 9819 3263 Mobile: 0417 135 302 Home Fax: 03 9882 3251 Email: [EMAIL PROTECTED] Web: www.hcn.com.au ----- Original Message ----- From: David de Bhál To: 'General Practice Computing Group Talk' Sent: Saturday, February 11, 2006 4:01 PM Subject: RE: [GPCG_TALK] Details of Public Coag Outcome   The GREATEST impediment is Medical Director. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of David Guest Sent: Saturday, February 11, 2006 1:41 PM To: [EMAIL PROTECTED]; OzdocIT Subject: Re: [GPCG_TALK] Details of Public Coag Outcome Tim Churches wrote: >David More wrote: >  > >>Progress Towards Electronic Health Records >> >>To underpin the efforts in refocusing the health system to promote better health and >>community care for all Australians, COAG agreed to accelerate work on a national >>electronic health records system to build the capacity for health providers, with their >>patient's consent, to communicate quickly and securely with other health providers across >>the hospital, community and primary medical settings. The Commonwealth will contribute $65 >>million and the States and Territories $65 million in the period to 30 June 2009. >>    >> > >That sounds less like the former HealthConnect vision of huge, shared, >central repositories and much more like a vision of a far more >distributed electronic health record (or rather, an "electronic health >record system") enabled by quick and secure communication. OK, I have >just restated the preceding paragraph - but my point is that the >emphasis is on secure communication (implying between distributed >clinical information systems or repositories), not on shared central >repositories. > >Is that correct? >  > I was wondering if someone could paint the end user picture for me now that we will shortly have a secure distributed electronic health record. I am sitting in my surgery with Medical Director in front of me and the patient beside and have access to lots of data from my own sweat of the brow and from those specialists, pathologists and radiologists to whom I have referred the patient. The patient tells me the name of the last doctor they saw on holiday, the hospital where they were admitted and their Australian patient identification number. What's next? I can see various scenarios and impediments to their implementation but would be interested in those with the vision thing. For my own part, I would like *my *medical record to clearly delineate the "not invented here data" of which I now have a ?permanent copy. David -- "UFW. Deb does linux." SIP [EMAIL PROTECTED] NodePhone +61 7 31290168 Jabber [EMAIL PROTECTED] _______________________________________________ Gpcg_talk mailing list Gpcg_talk@ozdocit.org http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk

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