RACGP election interview: Dr Frank Jones
Frank Jones is a GP based in Mandurah, WA, who believes the RACGP must lead the eHealth debate. A fan of general practice software, he believes interaction with hospital IT needs to be fixed before an electronic shared record can work.
In what areas do you feel IT could most improve general practice, either clinically, administratively or both?
First and foremost contemporaneous medical records are vital in clinical care: they are at the very core of our modus operandi! And IT has revolutionised the way I am able to practice medicine. GP IT is years ahead of our hospital systems. Having up to date progress notes, full summaries, recall systems and immediate access to pathology and radiology is now an accepted norm. However, as usual it's the quality of information input that is most important: 'rubbish in-rubbish-out' scenario! Most medical software is very user friendly; it really then behoves the efficient and caring medic to input correctly. We really have to 'code' patient contacts, so we can use this information to improve quality clinical outcomes: extraction of relevant data could be improved for some software packages.
I am always harping on about 'ticking the boxes' in the clinical history so that we can attempt to have a full picture of our patients. GPs now have a wealth of untapped clinical information within their systems which have the potential to completely alter the way we practice: GP based research emanating from our IT records will enable the profession to show government and our communities what a cost efficient and quality outcomes based speciality we really are.
Billing IT issues can be problematic and there is not one size fits all: my practice has had issues with various packages over the years. Practice principals need to have a careful look at what is on offer.
Have you used the PCEHR, and if so in what capacity? (e.g. to review patient information, upload a shared health summary etc).
Because there was no general agreement in the design and roll out of the PCEHR it failed. Even though there was clinical passion for a system, too many other players with different agendas impeded progress. As an example, as a practicing physician seeing a patient after hours I need critical clinical information which will guide me to deliver the best outcome for my patient. Let's get that bit right first! I do think an opt out system would be better. I have uploaded a few summaries but to no advantage to anyone at this stage.
What do you think about the PCEHR in its current form?
Medical practitioners need vital pieces of clinical information quickly-as outlined above: the summary clinical section in its present form is just acceptable. A space for advance health directive/planning will become increasingly critical in the interaction between community physicians and emergency departments. Interaction between my desktop software and the PCEHR is not smooth.
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?
Yes, the College's paper of November 2013 is a sensible, reasoned and reflective response.
What future role do you see for the National E-Health Transition Authority?
Whatever governance is in place it must be clinician led otherwise it will fail. General practice and the RACGP must be integral to any process.
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?
There is little detail about the modus operandi of the proposed Primary Health Networks and so it's difficult to comment; suffice it to say that most MLs have had a limited role within general practices' IT systems. (Division IT input was extremely useful). MLs did have a space in rolling out the PCEHR, but any proposed organisation in this space must take into account the amazing in-house GP systems we already have in place: the systems have to be able to talk to each other!
It is said that PHN will align with Local Hospital Networks: if this means the states' public hospitals, their IT is 5-10 years behind general practice software and there is extremely limited IT interaction. This needs fixing even before the electronic shared record.
Have you conducted any telehealth consultations, and how do you think the regulatory/remuneration structures for the provision of such services could be improved?
Huge potential, and will become more commonplace. I have done a few: initial targeting should still be for rural and regional colleagues. For urban practices I see a great opportunity for RACF consults and HIH patients. Telehealth consults have to be clinically appropriate: more educational modules need development. Remuneration has to be based on a proper business case.
What clinical software do you use in your own practice?
If you had to pick one area for improvement in this software package, what would it be?
The billing system: happy to expand on problems we have encountered!
Posted in Australian eHealth