Richard Hosking wrote:
This could be the issue that finally kills divisions - if they dont get
good takeup of such a program, govt will blame them. I doubt they will
have either the expertise or the money to persuade GPs. Still a national
deidentified dataset could be very valuable. You never know.
Richard,
This is even MORE interesting. I wasn't aware of this press release.
Your comments also are significant.
Once again, I think this discussion about de-identified data needs to be
watched closely. in many respcets it can't be useful to GPs if it is
de-identified, including to source, and even if the GP is identified,
he'll want to know who the problem patients are. The Adelaide West atlas
doesn't use de-identified data. The resource/skills issues Richard
raises are accurate.
My comments to our new RHIMO, sent yesterday, follow:
On 12th July I met Jan McRobie at the Alliance, in conjunction with most
of the other Division IM&T officers from the Sydney/Newcastle/Wollongong
area. As you may be aware, a minority of Divisions have maintained IM&T
staff, and we meet regularly.
A number of issues, relevant to 23/08 were raised with Jan, and I'll
summarise my take on them below, in lieu of our participation in the
teleconference.
Data existence:
In respect of diabetes-related data, there needs to be an Australia-wide
effort to encourage the uptake of HL7-encoded pathology results
messaging. The good news is that most pathology providers can now send
results that are HL7-encoded, but most are only doing so on request.
MD2 currently parses a range of diabetes-related values from HL7-encoded
pathology results, and places them into the relevant table in MD.
Without this taking place, any effort to extract data is reliant on
prior manual entry of these values, usually transcribed from electronic
or paper pathology results, which has proven to be done only on a very
limited basis.
The Division has been encouraging HL7-encoded pathology results uptake
for over a year.
Extraction technologies:
Canterbury currently has a pilot for diabetes data extraction using
Cardiab and Argus. Data is identified, patient and GP consent is
obtained, the project is ratified by our AHS ethics committee.
MDStats will only exist, ultimately, in MD3, and universal uptake of
MD3, by MD users is quite some way off yet. The Canning Tool requires a
trained person to use it.
GP co-operation:
This is largely yet to be determined.
Divisions have some level of co-operation from GPs, but the area of
widespread data extraction is new ground. Concerns about increased
government scrutiny, privacy concerns, risks to practice information
systems, cost, time constraints, and other factors, may impede GP and
practice participation. GPs may/should expect remuneration for data
provision, via the PIP, or some other less prerequisite-bound funding
mechanism.
Division resourcing:
Promotion, data extraction activities, database management will all
require increased Division-level resources. Most divisions no longer
have IT qualified staff. Using these technologies, understanding them,
installing extraction tools at practices and assisting practices to use
the tools, all requires IT qualified staff.
Practice resourcing:
Will practices have the resources to manage tools, or will they expect
Division to provide staff to do this? How good will be the resulting
information fed back to practices, and will they see at as adequate
compensation for their participation. Most practices have limited
expertise available to them, and have relied on Divisions for training
in use of their information systems. Most are still under-resourced in
terms of end-user and system management skills. Matthew Rose's studies
from ACTDGP are still the best data on this.
72% of our GPs have clinical systems, but not all receive pathology
results electronically. Michael Kidd's recent article in MJA gives some
idea of the relevant national position, but I suspect that it is optimistic.
Risk management:
Public liability insurance must be held by Divisions. These insurers
will not indemnify Divisions in the event that staff cause damage to
practice computer systems, or loss of clinical or practice management
data, unless the Division staff in question have suitable qualifications
and experience. We have been providing evidence of my qualifications and
experience to our insurer annually for this reason. Similarly, Divisions
will be responsible for the accuracy of data fed back to practices from
this process, that may have a bearing on clinical outcomes for patients.
Privacy/security/consent:
The feedback loop in your model mentions, on the one hand,
'de-identified' data but also talks about feedback to practices. It
seems very likely that many GPs would want patient data to be
identified, so they can target 'problem-patients', and in order to allow
any feedback, the data has to be identified by GP, which raises a range
of consent and GP privacy issues if the data is to be collected at
Division-level and passed on in some form.
Our experience with Argus suggests that providing meaningful GP feedback
may be time-consuming, and determining the form[s] of feedback most
useful for GPs raises further issues.
Greg
Wal Tracey wrote:
Andrew et al
Perhaps someone should ask Kate Carnell CEO of our very own ADGP who
was a member of the board of the Pharmacy Guild
& who no doubt seems to have strong contacts in Pharmacy as evidenced
by the partnership she & the ADGP seem to be promoting eg the
Memorandum of Understanding between ADGP & the Pharmacy Guild
http://www.psa.org.au/ <%00http://www.psa.org.au/>
http://www.guild.org.au/public/aboutguild.asp
<%00http://www.guild.org.au/public/aboutguild.asp>
the above links explain the structure of the Pharmaceutical Society of
Australia, which is the professional organisation for Pharmacists and
the Pharmacy Guild of Australia which is, and always has been the
business arm of the profession. Full membership of the Pharmacy Guild
is only open to Pharmacists who own their own pharmacy.
Last year I received a copy of a document titled *THE IMPLEMENTATION
OF GENERAL PRACTICE AND DIVISION PERFORMANCE IMPROVEMENT AND
MEASUREMENT TOOLS WITHIN A NATIONAL E-HEALTH STRATEGY*
following is an extract ADGP, in partnership with the Adelaide
Western Division of General Practice (AWDGP), the Top End Division of
General Practice (TEDGP), Pen Computer Systems Pty Ltd (PCS), HESA and
(probably) Cybertrust will collaborate to implement a national secure
network. This “web-based” service establishes the technical basis for
national general practice and divisions’ engagement in the E-health
environment with particular emphasis Divisions’ requirements under
Future Directions, Primary Health Care service delivery and population
health reporting.
The initial implementation has 3 interdependent components.
A National “private” internet system (VPN) that will allow authorised
GPs, practice staff, or Division network staff to access the network
and view information within their delegation. Cybertrust is the agency
that will probably host the programs and data servers. The ADGP will
be the custodian of the de identified data on behalf of its membership.
The appointment of skilled health informatics professionals to lead
the understanding and implementation of national intranet deployed
programs within the divisions.
The provision of 2 information systems that will bring immediate
benefits to interested general practices and to divisions faced with
the challenges involved in implementing the Future Directions
initiatives.
The Practice Health Atlas
The Practice Health Atlas, developed by the AWDGP, aims to inspire
general practice teams to document their activities and to develop
business models for more effective health care services and outcomes.
It is based on the synthesis of relevant, high quality and timely
practice health data, as well as using such data to predict future
health care needs and trends.
Data Aggregation tools
These tools will assist GPs and divisions in the collection and review
of National Performance Indicator information as required by the
Future Directions Policy. This software system will provide simple
procedures to allow GPs to examine their own practice indicators and
provide secure carriage of agreed, de-identified data to the Divisions
Intranet. This information can only be viewed by authorised persons.
This Intranet could support other initiatives in time. Examples,
without prejudice, could include support for Home Medicines Review,
Electronic Clinical Decision Support, and tools to provide electronic
support for team-based care planning.
At the time this document was current I was the TEDGP GP Leader in IT
and I was not privy to any of this planned activity.
Pen Computer Systems very reluctantly spoke to me and the plan
appeared to be that their software would be installed on GPs desktops
and extract data for Divisions.
This appears to be coming to fruition now with the ADGP roadshow led
by Ms Carnell and pushing the concept of Divisions extracting
prescribing data from participating GPs for use by Divisions to
presumably extract more Commonwealth money.
http://www.pencs.com.au/files/ADGPMediaReleaseforIMITProgram.pdf
To summarize, we have an organization which attempted to hijack
medical communications for their own pecuniary advantage, allied with
an organization purporting to represent GPs but rarely if ever talking
to them, trying to sell us the idea of handing over our patient data.
Wal
--
Greg Twyford
Information Management & Technology Program Officer
Canterbury Division of General Practice
E-mail: [EMAIL PROTECTED]
Ph.: 02 9787 9033
Fax: 02 9787 9200
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