At 6:44 am +1000 15/8/06, Geoff Sayer wrote:
Peter MacIsaac wrote:
"In brief the value of SCT will need to be looked at in terms of
functionality of their current IT systems and where the users expect to be
in future. (The aim is that the end user should not be making decisions or
even knowing that they are using SCT (once appropriate interfaces have been
developed- we might be a bit away from that at present.)"
Hi Peter
But what will clinicians really get out the interface after it is specified
and developed? There are already interfaces out there that have controlled
medical vocabulary and decision support systems running off them.
What is the real benefit of having SCT behind it instead of DOCLE or
ICPCPLus for example? As far as the GP is concerned it is just a big list of
words - I would argue that most of the vendors would see it as a just a big
list of words as well.
It is a little disconcerting that after so long for a national license to be
obtained (at some expense I would imagine) that it seems to be somewhat
difficult for benefits to roll off the tongue over the existing systems and
terminologies that are already in place.
To get the debate going I have thrown out some questions to help Jon along
Will SCT result in better care? If so how?
Will SCT make GPs more money? If so how?
Will SCT mean that GPs are less likely to be sued? If so how?
Will SCT make software development easier? If so how?
Will SCT make software licensing cheaper? If so how?
Unless you can mount these types of arguments I wouldn't worry about
interface design - these types of things need to be shown if it is going to
be implemented and demonstrable differences are going to be obtained.
Geoff
I thought the business case had already been formally researched and
presented to NeHTA some time ago. It would be nice to see that
documentation. Does the fact that NeHTA is a private company mean
that FOI legislation does not apply? If so, well done.
I suspect the answers to all Geoff's questions are *no*, but...
To me the business case can be articulated thus:
* to communicate coded information in a "shard care" setting, one
either has to share the same codes or translate every "message"
* translating *every* message has a cost
* the cost of people intervention time to achieve this can be
estimated - (hospital discharges/year) x (average number of discharge
diagnoses per discharge) x (GP time to re-code each diagnosis) x
(cost of GP time)
* based on numbers I found to plug in more than a year ago, and
putting in 10 seconds of GP time, I got a number around $1M/year
So I think some questions to ask are:
Will use of a single coding system save money in recoding time? YES
Will changing the base coding system in GP systems result in better
care? probably not
Is SCT the right choice of a single coding system? ...probably as
long as we know why we're using it
Will use of a single coding system result in loss of richness of
information on which clinicians will make decisions? YES, because
there will be health system pressure to record codes and not express
richer "clinical utterances"
What will be the potential cost in patient harm of incompletely
expressed clinical information to make clinical decisions in a shared
care setting?
I have seen a good paper that sharing care among more than one
provider, even where the electronic record is common, produces worse
outcomes. I can relate first hand examples.
ian
--
Dr Ian R Cheong, BMedSc, FRACGP, GradDipCompSc, MBA(Exec)
Health Informatics Consultant, Brisbane, Australia
Internet: [EMAIL PROTECTED]
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