David de Bhál wrote:
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”
David,
Much better promotion for your product than your website, which leaves
'non-members' completely uninformed about what you are selling.
Dissing Andrew, his product and their business model is still no
substitute for an open site with real information, however.
Greg
--
Greg Twyford
Information Management & Technology Program Officer
Canterbury Division of General Practice
E-mail: [EMAIL PROTECTED]
Ph.: 02 9787 9033
Fax: 02 9787 9200
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