Sorry guys, I pushed the wrong button and sent this to the 'old' GPCG
list, when I intended to send it to this list. Apologies to those who
are getting it twice.
I'd better have an Easter egg and raise the theobromine level in the
neurons a bit.
-------- Original Message --------
Subject: Comments on Ian Reinecke's presentation at CHIK Health-e-Nation
conference
Date: Sun, 16 Apr 2006 09:18:26 +0930
From: Oliver Frank <[EMAIL PROTECTED]>
Reply-To: [EMAIL PROTECTED]
To: Ian Reinecke <[EMAIL PROTECTED]>, GPCG_TALK
<[EMAIL PROTECTED]>, [EMAIL PROTECTED]
Dear Ian,
I have been looking at the slides from the presentations at the recent
Chik Services Health-e-Nation Conference:
http://www.health-e-nation.com.au/index.php?page=56
including your slides at:
http://www.chik.com.au/files/HeN2006/ReineckeHeN06.pdf
Your presentation provides a good overview of the situation and what is
being done to work to improve the handling of information in our health
system.
I would like to make some comments on your presentation. CHIK or you
has forbidden copying the text of your slides (is there an important
reason for this?), so I have laboriously re-typed your text, hopefully
correctly.
I see in your slides that you have classified the health care system in
Australia as:
"Secondary care - delivered by a mix of states, territories and private
providers
Primary care - GPs & specialists; federal government as primary funder
Healthcare services - pathology, radiology, pharmacy etc, delivered by
private and public providers"
While I suppose that there is no 'official' or 'correct' way to classify
the various parts of the health system, I have to say that I found your
analysis novel. I believe that medical specialists (presumably you were
referring to medical specialists) provide little primary care in
Australia. Primary care is generally understood to involve health
professionals to whom the patient can refer himself or herself.
Conventionally this includes GPs, as you have mentioned, but also
pharmacists (whom you have listed further down only as providing
'healthcare services'), and physiotherapists, dietitians, psychologists,
podiatrists and a wide range of other registered and unregistered,
scientifically-based and non scientifically-based health practitioners,
such as crystal healers, colonic irrigationists, aromatherapists and so
on. Medical specialists are generally understood to be providing
secondary care, that is, they see only patients who have been referred
by another health practitioner. I think that you have confused the
distinction between care in hospitals (misleadingly often referred to as
the 'acute care sector' - GPs provide acute care all the time) versus
care outside hospitals, with the difference between primary care and
secondary care. Just to confuse the picture further, hospitals, which
are probably intended by their funders to provide mainly secondary care,
do also provide primary care by allowing anybody to walk in to their
emergency departments and be seen for problems that could have been
treated often better and usually much more cheaply in primary care
settings such as general practice.
In one of your later slides titled 'Rising demand for change', you say that:
"Commonwealth pressing for common technical and information standards to
be adopted by GPs and specialists
Private sector healthcare providers recognise the need for common
information transfer standards"
While both of these statements are true, they give the impression that
GPs and other doctors are reluctant about the adoption of standards for
information and the transfer of information. This is not true at all.
This slide fails to acknowledge that the medical profession and GPs in
particular have for many years been very actively 'pressing for common
technical and information standards' to be adopted. One of the main
reasons why GPs have been clamouring for national standards is because
GPs have been and still are the most computerised part of the health
system. GPs have spent a lot of their own time and money and some
Commonwealth money to create electronic clinical records, which has
improved the quality of care that they can provide. GPs have then have
had the frustrating experience of being unable, because of a lack of
standards, easily to keep using those electronic clinical data in new
clinical software packages or to exchange those data with other doctors
and health professionals caring for the patient.
It fell to me on the 3rd August 2000 to announce at the National Summit
on E-Health the recommendations of the General Practice Computing
Group's Coding Jury for a clinical coding system to be used in
Australian general practice. That announcement is approaching its sixth
birthday still unfulfilled. The recommendation was that SNOMED should
be adopted eventually and that is what NEHTA is now working towards, so
we may get there one day. It is my understanding that the parties who
prevented the adoption of the interim standard (ICD 10-AM) that the GPCG
Coding Jury recommended were not the medical profession but a range of
government and government-related departments and organisations, all of
whom apparently had their own reasons for opposing the recommendation.
I am not clear about the role and attitude of the medical software
industry, but as far as I know it has always said "We don't care which
coding system is to be the standard. Just tell us what the standard is,
and we will make our software conform to it."
I do understand that the vendors in the medical software industry may
have commercial reasons for not welcoming a standard or standards that
allows their users easily to change clinical software packages. This of
course works against the interests of their users. Perhaps it is a form
of anti-competitive behaviour that the ACCC would like to investigate?
I hope that my explanation will help you in your future talks and
publications to portray the roles and attitudes of GPs and other players
in the health system in what I believe may be a more accurate way. I
hope that my colleagues on the GPCG list may also contribute their
perspectives and comments.
Best wishes,
--
Oliver Frank, general practitioner
255 North East Road, Hampstead Gardens, South Australia 5086
Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683
--
Oliver Frank, general practitioner
255 North East Road, Hampstead Gardens, South Australia 5086
Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683
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