RACGP election interview: Dr Harry Nespolon

Sydney GP Harry Nespolon has acted in various roles with the AMA, Divisions of General Practice, Medicare Locals and in general practice training over the years. He is not afraid to say that he thinks the PCEHR implementation has been a disaster and that “Medicare Locals were trying to blow up an eHealth balloon with a hole in it”.

In what areas do you feel IT could most improve general practice, either clinically, administratively or both?

IT has improved the clinical management of patients, especially chronic and/or complex patients. Reminders with clinical software help to ensure that patients have there recommended treatments suggested. The ability to look up reference material during a consultation is a bonus. Administratively, it is now impossible to efficiently run a practice without adequate practice software. If I could have one wish, it would be that all correspondence, especially specialist letters, be sent electronically, from a global address book.

Have you used the PCEHR, and if so in what capacity? (e.g. to review patient information, upload a shared health summary etc).

I have uploaded one PCEHR. My patients in the lower north shore and the city of Sydney are either extremely suspicious or just don't understand what a PCEHR is. Many 'signed' up in the practice but never completed their enrolment. I tried to sign up for my PCEHR about 4 times, and failed every time. If I cannot do it, I cannot expect a disinterested patient to do it.

What do you think about the PCEHR in its current form?

Seemed to be designed by engineers not clinicians; dumb name, excessively complicated practitioner sign up, completely bamboozled patients, poorly explained to the profession (so many unanswered questions ), unknown functionality, unknown benefits.

Do you agree with the college’s position that future functionality should be put on hold until existing functionality is improved and adopted by doctors and other health professionals and organisations?

The reality is that the implementation of the PCEHR has been a disaster. There needs to be a change in the 'culture' around the e-records. Changing the name is a good start. Just starting with medication list (for example) and recording all immunisations (adult and children) might provide practitioners and patients with good reasons to be part of the eHealth EVOLUTION. If the government really believes in the benefits of eHealth there needs to be separate identifiable remuneration for contributing GPs.

What future role do you see for the National E-Health Transition Authority?

I do believe in the importance of having a functioning and useful eHealth record. Patients are extremely mobile and the medical care they receive is becoming increasing complex. There needs to be an organisation, whether it is a NEHTA or another authority, that is taking responsibility and leading the development of eHealth in Australia.

Medicare Locals are to be collapsed to a lesser number of Primary Healthcare Networks with funding for Medicare Local eHealth officers concluding. From an eHealth perspective, what material impact do you think these realignments will have on your own practice, and the practices of other RACGP members?

The Medicare Locals were trying to blow up an eHealth balloon with a hole in it. Before PHNs can be effective in the promotion of eHealth there needs to be a functional electronic record for both patients and doctors. It has to work for all stakeholders. Once a practical electronic record is established both practitioners and patients will want to be part of a system, and will need support to fully implement the system. There will be no material change to practices until a functional and practical PCEHR system is developed.

Do you see a future role in eHealth for PHNs, and if so in what capacity?

eHealth can help with monitoring of acute medical conditions and population health measures for the PHNs. This will help the PHN develop programs for both practitioners and patients relevant to their area.

Have you conducted any telehealth consultations, and how do you think the regulatory/remuneration structures for the provision of such services could be improved?

I have not conducted telehealth consultations. I would have to consult with my rural colleagues about how this essential form of consultation could be improved.

What clinical software do you use in your own practice?

Best Practice.

If you had to pick one area for improvement in this software package, what would it be?

Better Workcover management.

Posted in Australian eHealth

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