Tom Bowden wrote:

> The main point I'd make is that if you can design a health system that
> puts the GP in a good position to manage his or her
> patients' general care then the GP is probably the best steward of the
> patient's EHR rather than a repository somewhere in the ether.  This
> was I believe the main point of the article I quoted.  Certainly, we
> are designing and implementing systems that will allow the GP to be
> steward of summary patient record that he or she will allow another
> provider with a relevant need to access this summary information when
> really needed.  However a major proviso rules out pursuing this
> approach in Australia at the present time.  That proviso is that to be
> successful an IT system architecture must fit within/support a health
> system architecture and currently the Australian health system does
> not yet put GPs  in such a position to direct and manage patient
> care.  To do so the GP needs patient enrolment, capitation and perhaps
> budget holding as well.
>
I think we are getting there, Tom. NEHTA seems to agree with us.

I hope if the architecture is right we can avoid patient enrollment and
capitation. Only a few patients have more than one GP. (Well only a few
of the sick ones that is.) Budget holding is not related to data
management. It is a government tool to limit services and is intensely
disliked by patients and doctors alike. We're only two years out from
another election so I cannot see that happening for at least 3 years.

With all due respect to the bureaucrats and specialist colleagues on
this list, like you, I cannot imagine anyone other than the GP being
either capable or interested in taking on this role. Even with NHfIT
it's still going to be the GP managing the patient and their data,
except the data is now on the other end of the ADSL / fibre.

Cheers.

David


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