Listen to the heartbeat

Primary care was back in the news this week, highlighted by yesterday's announcement that Fred IT had won the tender to build Victoria's new real-time prescription monitoring system, with ReferralNet and Argus scoring a few runs on secure messaging, a new survey out looking at the digital general practice, and a whole gang of diagnostic imaging software vendors signing up for the My Health Record.

The survey, carried out by online booking, recall and reminder service HotDoc, had a number of very interesting nuggets – not the least of which is that yes, sometimes your patients will pay to not have to come in to see you – but also the finding that most people use online booking systems not for their own convenience but so they can book their personal doctor more conveniently. A good proportion are also willing to follow their doctor when they change practices, which just reiterates what everyone has been banging on about for years now about how the relationship between doctor and patient is a special one.

This was brought home for Pulse+IT at the RACGP eHealth summit in Melbourne this week, when Canberra GP Trina Gregory gave a quite remarkable presentation in tandem with her patient Tom Skotnicki, a recovering journalist and recent liver transplant recipient who is also an old friend of RACGP eHealth chair Nathan Pinskier. Together, this powerhouse duo told us a few home truths.

In a nutshell, Mr Skotnicki is a poster child for how information exchange in our health system is a shambles, how this shambles has the ability to severely harm or kill patients, how the My Health Record is really not helping at all at the moment, and how the GP remains the absolute lifeblood and heartbeat of the healthcare system.

The summit brought together a diverse range of people as well as a number of well-known GPs who can be considered stalwarts of eHealth, they being the ones who have stuck it out through the promises and the pratfalls of eHealth over the last decade: Dr Pinskier and Dr Gregory, former AMA president and NEHTA clinical lead Mukesh Haikerwal, fellow Melbourne GP and noted Maxwell Smart enthusiast Rob Hosking, the gracious Oliver Frank, the magnificently moustachioed Chris Mitchell.

Quite a few of these GPs have ridden the highs and the many lows in the evolution of eHealth and quite a few of them famously walked out on NEHTA when that organisation famously disappeared up its own fundament. Yet here they are, still plugging away and hoping beyond hope, hoping that Mukesh's infamous piles of paper waiting to be scanned will finally evaporate and their dreams of seamless transfer of information will finally be realised.

It still could happen. Pulse+IT attends a lot of digital health conferences and they are usually pretty good, but we do find that some are apt to oversell the benefits of eHealth when few if any of those benefits have been or will ever be realised. We reckon it's always a good idea to get the lowdown from the actual people doing the healthcare, whether that's at a GP summit, a conference of nurses or a gathering of aged care types.

Back at the summit, Australian Digital Health Agency CEO Tim Kelsey recounted how he had received some great feedback from GPs about the new medications in the MyHR, surprised as they are that they can now find something useful in the system. We've heard the same – the case of the unconscious patient who wasn't given a routine drug in ED because of an allergy alert on their MyHR and who is therefore still around to talk about it; the clinicians reporting that they can now contact other health professionals about a patient's meds due to the data on the MyHR.

But the people we should really be listening to are Trina Gregory and her patient Tom – who is, ironically, a former adviser to NEHTA. Trina and Tom think that the current, unreconciled list of medications on Tom's MyHR, which mixes some of his current meds with some of his ceased meds and some of those that no one is quite sure about, makes consulting the list potentially more dangerous than knowing nothing at all.

This really needs to be sorted, and the answer should start with consulting the GPs. They inevitably infuriate the policy makers and evangelists with their intransigence, their cynicism, their dogged insistence on safety, on getting it right, on following workflow, on measuring risk, on confronting barriers, on having sound evidence for everything they do. But they are inevitably right, and we should listen to them.

We are of the opinion that the digital health agency does listen more often that not, but everyone needs a reminder now and then. And like the GPs at the summit, our readers are still cynics, as our polls show. Last week, we asked if ADHA deserved a pass or a fail grade on its first year in operation. We here at Pulse+IT were neutral but our readers were split: 55.5 per cent give them an F, while 44.5 give them a pass.

This week, we ask the question: will GPs eventually see value in My Health Record? Sign up to our weekend edition or leave your comments below.

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