See comments below
Dear Geoff,
Three things that I believe would improve general practice would be:
1. An agreed way of structuring clinical and billing data that allows
GPs to use any clinical and billing packages they want with the same
dataset. That is, if I want to, I can use Genie for my first
consultation today, Profile for the next and Medical Director for the
third. They all read from and write to the same dataset. This would
allow GPs freedom to change easily from using one software package to
another as they wish.
Oliver is dreaming of GP nirvana. It's good to dream but I think this
particular item is fantastic (as in the stuff of fantasy). I cannot see
how the proprietary vendors would agree on a base structure. It would be
like having all your email data on a server and then using an email
client:- Outlook, OE, tbird, sylpheed, mutt, webmail to retrieve, filter
and process that data. Oh wait, I think we can do that.
It would certainly be against the commercial interests of the main
players to allow this
Perhaps a second best is well documented scripts/processes to allow transfer
2. All forms that outside agencies like Centrelink, driving licence
authorities, etc. want us to complete for patients are available
either online via the Web, and are populated automatically from the
information that we already have in in our clinical record (which we
can edit in the online form as required) OR are generated
automatically from within our software package (for example, like the
South Australian Prescribed Medical Certificate for Workcover claims)
and able to be emailed securely automatically. It is important that
these agencies do NOT ask repeatedly for information that is static
and not going to change, for example, the patient's date of birth, or
the nature of their permanent disability e.g. blind from birth.
So kind of like a web service where their server queries your server and
all the fields are auto-populated and a form is thrown up for the doctor
to complete the fields with missing data. You'd have to think it would
be worthwhile for the government to fund such an undertaking. Perhaps in
their laissez-faire way they think the "market" of government run
agencies will cause the most successful form to emerge.
Some government departments are very hip and provide their forms on line
in pdf format. This is a madness, as Ken would say. While it is not
strictly true, they say they like pdfs because they are unalterable. It
is certainly difficult to alter them while largely retaining the
original structure, but that's what we want to do. We want to complete
an electronic copy, preferably automatically from our databases, and
send it to them in any way they want. At their end this is probably
still paper or it could be an electronic pdf or it could just be an HL7
CDA document processed automatically by their computers. It's been a
long frustrating business trying to wean the Feds off paper but I do get
the feeling that the day of electronic exchange of data is closer.
Again I think we underestimate the "vested interests" in the current
system. Bureaucrats are not going to allow the process to be so
efficient that they are out of a job.
The only way it will happen is if GPs
(1) have a process to allow it to happen electronically
(2) Just flatly refuse to do it any other way - after all the work we do
for Centrelink is unpaid - I will be quite happy not to do it at all. It
is generally not a health issue, but rather is related to the payment of
benefits. As far as I know I have no legal duty to conform to
Centrelink's demands. This work often raises dilemmas and stress when my
view of the patient's disability does not agree with their's. We are
acting for Centrelink here rather than the patient.
3. A method of providing test results to patients automatically e.g.
by the patients being able to access their electronic medical record
and read our comments and advice about the results. Medicare needs to
fund our costs in providing this service - that is, payment for our
time spent writing our comments and advice.
I dont see this as a good option. It is often not the results that are
important, but their interpretation. If my legal duty of care was
discharged by simply allowing the patient access to their results then
OK fine, but I suspect I have to provide some interpretation and a plan
of action.
R
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