>From what I have seen of AGPAL inspections or more the 'inspectors' I would
not trust them to certify any software not even Solitare.
The basic mistakes they make from purely an I.T. persective are a laughable.
During one site inspection a GP was chastised for not locking his pc screen
saver when he left the room leaving only the inspector in the room. He left
the room as a receptionist banged on the door as she has a patient in
reception who had severe chest pains. Note, there was no patient in the room
just an AGPAL inspector who one would assume could be trusted.
Then when the GP re-entered the room the inspector proceeded to explain how
easy it is to lock the screen using the windows key and the letter L. How
true but...
The inspector then went on to say just use 'zz' as your password so its
quick and easy to unlock.
Gee how long is it going to take any patient to work the password out ?
So the password is now worth ?
I could fill pages with similar stories but that would only embarrass
people.

So lets come up with a more I.T. creditible organisation to help Oz clinical
software hey !

How do we rate the vendors support ?
Run a website and request practice managers to log into it while they are
waiting on hold and rate the responses ?
Collate it over time with a live tally.

HCN today - 7 min wait
HCN calls logged today - 167
HCN time to talk to tech - 16 min
HCN this month - 8 min wait
HCN time to resolve issue - 3 months
IBA today - 2 min wait
IBA calls logged today - 54
IBA time to talk to tech - 59 min
IBA this month - 8 min wait
IBA time to resolve issue - 3 months
Intrahealth today - 22 min wait
Intrahealth calls logged today - 11
Intrahealth time to talk to tech - 22 min
Intrahealth this month - 16 min wait
Intrahealth time to resolve issue - what issue we have no issues :)

Andrew
Gold Coast.

-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
On Behalf Of Oliver Frank
Sent: Saturday, 24 February 2007 3:31 PM
To: [EMAIL PROTECTED]
Cc: [email protected]; Ross Davey
Subject: [GPCG_TALK] Re: [Nat-Div] Accredited software

[EMAIL PROTECTED] wrote:
> It is an interesting suggestion that practices should only use 
> clinical software that has been approved by AGPAL and is itself- 
> accredited, by a new set of clincial software standards which is being
mooted by Drs and Practice Managers.

AGPAL and GPA do not set the standards for practices.  The RACGP sets the
standards and the accreditation organisations decide from their inspections
whether a practice meets those standards.

Who do you believe would set the standards for clinical software? If not the
RACGP, what are your reasons for nominating another organisation?
> 
> Suggestions for these new standards for clinical software are:
> 
> 1. Acknowledgment and Response to users wishes with bug fixes, wish 
> lists, patches and updates - in a timely manner- reflective in a Users 
> Participation Survey

I want my clinical software to know when I will be walking in to my surgery
in need of a strong cappuccino, to order the cappuccino from the coffee shop
across the way and have it delivered to my desk in time for when I sit down
at it.  If my clinical software vendor doesn't respond to this important
wish on my wish list by developing and installing this very useful and
much-needed feature within three months, I will give the vendor a bad rating
in the AGPAL Users' Participation Survey.

Are you seriously suggesting that AGPAL or anybody else could work out a way
of rating a software vendors' quality of service in order to decide whether
that vendor's product should be accredited?

If I do rate my vendor's responsiveness to my demand for a prescient
cappuccino-making function as grossly inadequate and that vendor or that
software package fails to gain or loses AGPAL's accreditation, under your
proposal one of the consequences will be that my practice will lose its own
accreditation because it is using non-accredited software.  This may not be
the outcome that you had in mind.
> 
> Why is software the only thing in a practice
> which doesnt have to comply to some sort of standard!!   Everything else
does.

I am not sure that this is true.  There is not a standard governing every
single good or service.  It is my understanding that Standards published by
Standards Australia come into existence only when an industry decides that
there should be some standards for the goods or services produced by that
industry, *and* when people and organisations in that industry commit their
own time and money to the development of those Standards.  The development
of Standards is not funded by government.

If this explanation about how Standards are developed is correct, one would
expect the companies and organisations in the medical software industry to
initiate *and fund* the development of appropriate Standards for their own
industry.  Why haven't they done this?  I suspect that one reason is that
they haven't felt the need, another is that they don't actually have enough
resources to fund such an exercise, and a third may be that technological
change will rapidly invalidate any Standards that are developed.  I am not
sure about any other reasons.  I would be interested to hear from the
Medical Software Industry Association its reasons.  I will ask it and share
the answer with the list.

Alternatively, do you believe that GPs through one or more of our own
organisations e.g. RACGP, ACRRM, AGPN, AMA, etc. should develop standards
for clinical software?  Do you believe that GPs will be willing to devote
enough of their own time and money to develop the standards *and* to test
clinical software against those standards, keeping in mind that every new
version of each software package will need to be tested?

Those of us who are nearly as old as Greg Markey will remember that in
1988 the RACGP under Dr. Michael Crampton's direction developed and
published a set of standards for computer medical record systems, and
offered to examine clinical software packages against this set of standards
for a fee.  The creation of these standards was a significant innovation
that was recognised around the world. I witnessed this myself in 1993 at the
conference of the British Computer Society in Harrogate, when a computer
scientist working for the NHS' Sapphire software testing program held up the
RACGP standards document and talked about its importance.

Only one company, Medrecord, applied for the RACGP's software accreditation
and if I remember correctly its software passed the test. 
  I also remember very well the claim from other software vendors and from
other parties that the standards had been written to suit Medrecord, with
which the RACGP jointly was conducting the Computer-Assisted Practice
Project (CAPP).  The CAPP project was to examine the effects on practices
and on quality of care of implementing clinical computer systems.  Ross
Davey was, I think, an executive of Medrecord at the time and Peter MacIsaac
ran the CAPP project.  They and Michael Crampton, if he is reading this or
somebody points it out to him, may care to comment or to tell you more about
what happened at the time.

A few years later IBM was funded by Australian federal government to produce
a set of specifications of essential and desirable functions of clinical
software.  IBM did a good job and produced a sensible and comprehensive
report, but despite general approval of that report, it was never put to any
real use and is now largely out of date.  In the early 2000s, General
Practice Computing Group addressed the challenge of software accreditation
and funded some work to try to develop a system, but we all know what
happened to GPCG.  So you see, this idea of accrediting software is not new
and has a long history in Australian GP informatics, still without any
system of accreditation having been developed.

>  What about ISO9000 ? 

Can you say how expecting software vendors to gain ISO 9000 accreditation
would achieve what you are looking for?  At least one or two software
vendors do have ISO 9000 series accreditation.  For example Hatrix displays
the ISO 9001 logo on its Website at http://www.hatrix.com.au/  .


--
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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