Geoff, I have both a proprietorial and an educational interest in keeping up the standard of medical record keeping in a typical multi-doctor teaching general practice. Good records with easily accessible data saves me (the proprietor) money by making the doctors more efficient. Good records give me (one of the doctors) increased professional satisfaction because it helps smooth the flow of decision making. Good quality records help me (the privacy officer) deal better with inquiries by patients, and to respond the the proliferation of agencies, courts, lawyers etc who think they should rightly own the information. Good quality records allow me (the educator) to easily demonstrate to GP trainees blocks of progress notes, pointing out the good, the bad and the the ugly in record keeping, or at least it will again when a MD3 progress note decryption utility is finally released. I'm sure that my interest in good quality record keeping aligns conveniently with the interest of others who are positioned to make money (HCN and the purchasers of the data aggregated by HCN) or to save money (Government) if our data is clean. There will inevitably, however, be areas of conflict between the perfect clinician's EHR and the perfect data aggregator's EHR and for that matter the perfect centralised governmental EHR.
Tony Eviston Boonah Medical Centre Geoff Sayer wrote: > Hi all > > Long posting follows: > > I have watched (and actively participated in) GP data extraction and use of > GP data for a number of years now. The following might assist some who are > interested in thinking about why data quality and record keeping is really > important. As a psychologist and epidemiologist by training I think we > sometimes are actually missing the point of the role of the electronic > medical record and electronic decision support systems. > > For effective decision support through the electronic medium to occur a > number of assumptions needs to be considered: > - Effective decision support requires good medical record keeping > - Decision support can be a simple reminder, drug-drug interaction check or > use of a guideline in the diagnosis and management of a condition > - Decision support should be valued and not automatically dismissed by the > clinician without consideration > - Decision support does not replace the experience and training of a > critically thinking clinician > > There is a lot of interest in the potential of electronic records for > research and population health initiatives. However, it is important to > remember what the focus of the clinical record is about, directly assisting > patient care. > > It is possible to consider that there are in fact three levels to general > practice data: patient level; practice level and population level. In my > opinion it has become obvious that the order of importance is the respective > order described and that the issues while not exhaustive are key to > understanding the role of data in patient care, practice management and > population health. > > 1. Patient level: > - Clinical care is focused on the individual patient. > - Missing patient data leads to a greater risk of harm or less than best > care as decision support systems (human and machines) are not given the best > opportunity to function. > - Poor individual data limits the capacity for practice and Divisional > views. > > 2. Practice level: > - Clinical care of the practice population is considered by the clinician. > - Individuals get the benefit from practice wide strategies that assist in > the individual care of the patient. > - The effectiveness of practice wide strategies will be limited to the > quality of data available for individuals. > - If any one individuals data is poor, than there is a risk of missing out > on the practice strategy as they slip through the net. > > 3. Population level (eg. Division of General Practice): > - Clinical care is considered by GPs and the total population level is > considered by the Division. > - The Division needs to engage individual clinicians rather than focus on > individual patients. > - Data should initiate and evaluate intervention strategies to ensure > appropriateness and sustainability. > - Sustainable divisional level data collection must be a by product of > routinely collected "valued" clinical care data. > > There are many reasons for focusing on data. It is important though to > realise why you are looking at data or doing research in the field of > general practice, decision support or population health. Some of the reasons > include: > - Data provides the opportunity to instigate change. > - Any intervention should not occur isolated from data. > - Data give reassurance that change is occurring or has occurred. > - Data creates an environment of accountability and increased chance of > critical thinking and judicious decision making. > > I think that Divisions of GPs need to think about: > - Strategies that get GPs to value their own data for the care of their > patients. > - Strategies that get GPs to think about their practice population. > - Strategies that get GPs to see data as a means to instigate, maintain or > cease interventions. > - Strategies that collect population level data as a by product of routine > and sustainable data collections. > > The last point is easier if GPs are on board with the first three points. > > Source: The nature of this material has been published in previous lives by > myself in both academic and commercial settings. > > Geoffrey Sayer > HealthLink Ltd > > Note: The views contained in this email are my own and should not be seen to > necessarily represent current or former employers views. > > _______________________________________________ > Gpcg_talk mailing list > [email protected] > http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk > > _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
