Geoff Sayer wrote: > To get the debate going I have thrown out some questions to help Jon along > > Will SCT result in better care? If so how?
Yes, eventually, through better and much richer clinical decision support systems - not just drug interaction/contraindication alert systems as we (sort of) have now, but systems which suggest sensible lists of differential diagnoses or which seek out relevant clinical best practice guidelines or research summaries for your (trickier) patients and their problems, which prepare standard and appropriately evidence-based batteries of investigations and which make evidence-based suggestions for more rational treatment regimes, and so on. Also by enabling better aggregate-level comparisons of patient outcomes, properly adjusted for risk and clinical casemix - comparisons which allow early detection and further investigation of poorly performing outliers. Also by providing richer clinical information substrates for clinical and public health research on a population basis, moving us beyond reliance on expensive, slow-to-perform RCTs towards optimisation of real-life efficacy of treatment regimes. Pharmaco-epidemiology in particular springs to mind, both better adverse drug reaction surveillance and proper efficacy studies, especially given the annual expenditure on pharmaceuticals - both the life-saving subsidies by the govt through the PBS and private expenditure. None of this will happen overnight, but it will happen. > Will SCT make GPs more money? If so how? Unlikely. > Will SCT mean that GPs are less likely to be sued? If so how? Yes, better clinical decision support may well save the bacon of more than a few GPs in years to come. > Will SCT make software development easier? If so how? No, it will make it a bit harder, or at least more sophisticated interfaces will be needed, but so what? No-one said that software development should be easy or that the goal of clinical software development should be lower development costs in order to maximise shareholder value. In the big scheme of things (as in AUD$75b spent on health care in Oz each year), clinical software development costs are rather small and should not really be a worry to anyone except those in the business of clinical software development (or those with large shareholdings in such companies). We need to focus on teh big picture, not on how much it costs to hire a bunch of programmers. > Will SCT make software licensing cheaper? If so how? No, but why should anyone expect it to make software cheaper? > 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. I think the answer is that funding of pilot projects in suitable R&D settings is going to be needed in order to bootstrap SCT, and that we should not expect such R&D investment to come in the first instance from hard-nosed private-sector clinical software businesses, at least not if Geoff's response is in any way typical of such organisations (although I know that Geoff's sceptical take on SCT is not shared by all private-sector clinical software vendors, and that a few are very interested in and actively pursuing the potential offered by the national SCT license). Tim C _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
