Geoff

I often Betatested some of thes programs for HCN & let me tell you often
they caused crashes & problems.  At one stage as Betatester for MD2 I told
HCN I was happy to continue Betatesting MD2, butcan't test these data
extraction modules anymore as it makes my system to unstable. 

Who is going to take responsibilty when devisions load these software onto
Doctors computers and the GP phones comlaining that his computer is giving
problems.  Only as recent as Friday 07/07/2006 a Telstra technician upgraded
my ADSL modem to a ADSL-router modem because of BFH.  Now PS3 (HCN product)
has slowed down to a snails pace across a network.  Best Practice (BP) also
a SQL product behaves as normal.  It is now 3 days later & tech support
(HCN) still thinking about this problem.  Bob Lewin discovered this in
January 2006 (same ADSL-router).  Although they then worked out a fix -
involves piping commands etc., it just goes to show what happens when one
changes or load anything onto PC's.

The devisions unfortunately don't have the skills to then rectify the
problems, or like MS they'll use the excuse: Its not our software, but
something else causing the problem

Also what other spyware will be included in these softwares.  Surely a
promise from the government that it has nothing else imbedded is no
guarantee ??

The reason I computerised my practice is to make my life easier.  Not so
somebody out there can do research on my data etc.

Cedric

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**************************************************************************



-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
On Behalf Of Geoff Sayer
Sent: Tuesday, 11 July 2006 7:00 PM
To: 'General Practice Computing Group Talk'
Subject: RE: [GPCG_TALK] Why is GP data so important?


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.

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