Greg,

The College of Radiologists  (RANCR) has a project underway looking at
referral processes in radiology as part of the Quality in Diagnostic Imaging
Project. E-signatures is certainly on our list of issues to discuss with
Medicare Australia.  I have attached a project outline.

Any information you or other GPCG members might have which is relevant would
be appreciated. 

Regards

Peter MacIsaac


MacIsaac Informatics
Consulting in Health Informatics, Terminology & Data management and Health
Policy.

[EMAIL PROTECTED] 

0411403462 (mobile)
61611327 (office)
peter_macisaac (skype)

8 Ewart St. Yarralumla 2600


Regards

Peter MacIsaac
MacIsaac Informatics

Consulting in Health Informatics, Terminology & Data management and Health
Policy.

[EMAIL PROTECTED] 

0411403462 (mobile)
61611327 (office)
peter_macisaac (skype)

8 Ewart St. Yarralumla 2600

"We trained hard, but it seemed every time we were beginning to form up into
teams, we would be reorganised. I was to learn later in life that we tend to
meet any new situation by reorganising, and a wonderful method it can be for
creation the illusion of progress while producing confusion, inefficiency
and demoralisation." 

- From Pertonii Arbitri AD 66, attributed to Gaius Petronus, a Roman General
who later committed suicide. 


-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
On Behalf Of Oliver
Sent: Monday, 27 February 2006 12:39 PM
To: General Practice Computing Group Talk
Subject: RE: [GPCG_TALK] Electronic referrals between providers using the
sameEMR

> -----Original Message-----
> From: [EMAIL PROTECTED]
> [mailto:[EMAIL PROTECTED] Behalf Of Greg Twyford
> Sent: Monday, 27 February 2006 11:52 AM

> Duncan Guy wrote:
> > 
> > Question - if Doctor A writes in the progress notes - refer 
> to Dr B is that a valid referral?
> > 
> > Each Dr has their own unique logon - every entry into the EMR is 
> > labelled, dated and time as being entered by that Dr.

Greg Twyford replied:
 
> Either it's a written-on-paper, signed-in-ink, referral or if it's 
> electronic it has to be signed electronically with the referring 
> doctor's HeSA supplied-Medicare Australia approved individual signing 
> key, the famous, but least-used piece of technology in the health 
> sector, the RAINBOW iKey [dongle].

Greg, I think that if we looked at what is actually happening around
Australia, many GPs and specialists are simply politely ignoring Medicare
Australia's wish for electronic referrals to be signed with individual
digital certificates, and are just getting on the with the job of caring for
patients, as Duncan's group is doing.  A local specialist told me just the
other day that his group is doing exactly this - they are accepting
referrals without digital signatures and using them for Medicare benefits
purposes.

It sounds to me that the system used by Duncan's group of specialists
provides reasonable evidence that a referral was made.  I believe that
Medicare Australia would not and will not dare to try to prosecute any
specialist who used such a referral to issue an account which can be used by
the patient for the higher Medicare benefits payable for a referred service,
because it would be howled down in public by the whole profession as
obstructing the delivery of health care with inappropriate and unworkable
bureaucratic rules.  It's a bit like the Berlin wall - suddenly, just by a
kind of mass civil disobedience the whole thing (in this case, digital
signing) is seen as irrelevant and unnecessary and everybody just gets on
with doing the job that needs to be done.


Oliver Frank, general practitioner
255 North East Road, Hampstead Gardens
South Australia 5086
Ph. 08 8261 1355  Fax 08 8266 5149
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