Greg Twyford (or was it Andrew McIntyre? - hard to tell) wrote:
This is a recent PKI Signed message I received from a local GP.
With most Doctors computerised, most with patient recalls, and locally with Medical
Objects, I wonder if a system can be developed to faciliate patient prompts a month
before a Specialist referal is needed, to see their GP for a new referal.
This is a good idea. Can we refine it a bit? For some specialist
referrals, we expect that the patient will need to see the specialist
for only a limited time, but others are expected to have years of
continuing care. For example, yesterday I referred a man with a new
inguinal hernia to a surgeon. I expect the surgeon's involvement with
the patient to be for only a matter of weeks. I would not want to be
asked in 11 months' time whether the patient needs the referral renewed.
On the other hand, patients with say glaucoma often need to continue
attending the ophthalmologist for many years. Would it simplify things
to write an 'indefinite' referral for such patients, and be done with
it? The main problem that I have found with writing indefinite
referrals is that without a new referral letter in front of him or her,
the specialist sometimes forgets to write back to me. If I do write an
indefinite referral, I always include a paragraph which emphasises that
I want the specialist still to write to me after each contact that he or
she has with the patient.
In between these two situations of expecting specialist care to be only
for a limited time or for many years, we will sometimes be referring
patients not knowing whether they will need to see the specialist for
longer than a year. If we write such referrals as not indefinite (that
is, limited to one year), then it would be useful to have a system that
notifies the patient of the impending expiry of the referral, so that
the patient can attend the GP to discuss whether a renewal is needed,
and to get that renewal. The question in my mind is whose job this
should be. It is the patient and the specialist who want the referral
so that Medicare benefits will be payable at the referred rate, which
simultaneously decreases the patient's out of pocket expenses and
increases the specialist's income. I suggest that it should therefore
be our specialist colleagues' task to notify patients who the specialist
believes will definitely or possibly need futher care from the
specialist that their referral is going to expire, and advise the
patient to attend their GP to discuss this, *before* the patient makes
an appointment to see the specialist again.
For some time you have utilised your Recall system, which prompts you when a patient
is due for review.
Was the GP who wrote this talking about Andrew in particular or all GPs
in general, and if he is talking about Andrew in particular, why? Does
Andrew have some special recall system that other GPs don't?
A letter is then sent (by Medical Objects) to the GP saying that
their records say that a patient is due for review.
Why would such a notice come from Medical Objects rather than from the
GP's clinical software itself? What's it got to do with Medical Objects?
The GP can then contact the
patient to discuss this, see if it is appropriate, give a referal (or send it
directly via Medical Objects which removes the forgotten referal issue), > and treat
> all the other issues that inevitably arise during a GPs consultation.
> This is a good
> system that works for you, works for us, and works for patients.
If the GP contacts the patient and the patient says that he or she does
not need to see the specialist again, how much do you think that it
would be reasonable for the GP charge the patient for having contacted
him or her about the possible need for a new referral, and documenting
the telephone/email/postal discussion with the patient?
Alternatively, if a Specilaist sends a letter to a patient reminding them that their
appointment is due, and that they need a new referal, a copy could be sent to the GP
by Medical Objects, who could then flag the patient for recall to get a referal.
Why would the GP need to spend his or her time and money recalling the
patient if the specialist has already notified the patient of the need
for a new referral?
Without digital Signatures on GP Referrals sending them electronically
is a pandoras box - If the HIC audit the specialist, then without a
digitally signed referral or a signed paper copy they are liable for
prosecution
Technically they are, but are you aware of any specialist having been
prosecuted for having only a scanned copy of a referral, or for
accepting a referral that arrived by encrypted email without a digital
signature? I would ask Medicare Australia, but I am not going to,
because when the answer came back in several months' time it would be
vague and it would not answer the question.
, or at least a lot of ringing around!.
Not much ringing around. Maximum of one call per referral being looked
at, since each GP is likely to refer more than one patient to most of
the specialists that he or she uses.
Thats why Medical-Objects has not released a GP client to send Referrals
without a PKI key. technically its a piece of cake, but we do not want
to be a cause of HIC "Issues" in the future.
Fair enough. Those hundreds or thousands of us who are not worried
about this can continue using messaging systems that do allow us to send
electronic referrals that are not digitally signed but which do carry a
facsimile of our handwritten signature, or not even that.
--
Oliver Frank, general practitioner
255 North East Road, Hampstead Gardens, South Australia 5086
Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683
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