Snail mail still the method of choice for many GPs

A large minority of general practice staff still prefer to send medical records by post and fax despite the majority thinking that sharing records electronically had the potential to either streamline work or accelerate the referral process, a survey has found.

It also found that despite many practices feeling the pressure to increase bookings or cut costs, surprisingly few were using technologies like online booking or automated reminder systems.

And uptake of the PCEHR was very low, with only 16 per cent of rural and remote, 12 per cent of city-based and nine per cent of regional practices using the system.

The survey of 423 health professionals, conducted in February by clinical and practice management software vendor MedicalDirector, included 214 GPs and 134 practice managers as well as specialists and nurses.

Of these respondents, just over half (55 per cent) were from capital cities, about a quarter from regional areas (26 per cent), and a fifth from rural or remote areas (19 per cent).

The results appear in a white paper, Practice pressures and eHealth realities, which aims to identify the challenges health professionals currently face in terms of providing good patient care and sustaining their businesses, and to uncover opportunities brought about by electronic health systems.

To understand those challenges, MedicalDirector asked the survey respondents what kept them awake at night. Overwhelmingly, the survey found, the threat of government changes created the most concern.

Almost 48 per cent of respondents are worried government changes could have a negative effect on patient outcomes. They also said their practices were under pressure to cut costs or increase bookings due to speculation about changes to Medicare or the introduction of a co-payment.

Fourteen per cent said they have already seen a drop in patient bookings. However, practices don't seem to be turning to technological solutions to help. Only 17 per cent use an online appointment booking system, with another 10 per cent planning to do so this year, while only 28 per cent use an automated reminder system to notify patients of upcoming appointments.

And despite almost all respondents saying they used practice management or clinical software, 42 per cent still preferred to send records via post and fax, despite more than 70 per cent thinking that sharing records electronically had the potential to either streamline work or accelerate the referral process for patients.

According to MedicalDirector, these comments show that more needs to be done to make secure messaging work across technology providers.

“When you add up the cost of sending or receiving patient information via traditional mail, particularly with rising postal prices, you’re suddenly looking at hundreds of dollars and a lot of extra time spent stuffing and opening envelopes,” MedicalDirector CEO Phil Offer said.

“In this day and age, when health professionals have access to systems that send information quickly and securely via electronic means, many are missing a great opportunity to spend less time on paperwork, and more time with their patients.”

Rural and remote practices seem to be ahead of the curve when it comes to sharing records electronically, with only a third of those in a rural or remote areas opting to use snail mail.

They are also more likely to use the PCEHR, according to the survey, with 16 per cent likely to use it compared with 12 per cent of city-based and nine per cent of regional respondents.

When it comes to what technology trend they thought would have the most opportunity to benefit health professionals and/or improve patient outcomes, there was a fair split between the answers.

Twenty-six per cent thought health-related apps were the way of the future, 21 per cent thought telemedicine, 17 per cent said the PCEHR, another 17 per cent said online appointment booking systems, 10 per cent said wearable tech like Fitbit and nine per cent said check-in kiosks at the practice.

The white paper is available from the MedicalDirector website.

Posted in Australian eHealth


0 # Troy Bailey 2015-04-30 13:50
It’s an ongoing challenge to implement more efficient processes in general practice, the most successful way is through the use of technology, there is no argument. We need to be clear about the process of “sending medical records”, this is a complete record when a patient to another clinic or a reduced recorded when they are another clinic.

Since the up-take of Electronic Medical Records ironically the main barrier to the take-up of technology is and will always be the software vendors, not the GP. If their existing software has the capability and works with their exiting workflow it will be taken up on mass.

In relation to "sending complete medical records" electronically when a patient transfers to another GP, electronic communication has a two-way benefit and maintains continuity of care. We have the vast majority of general practices sending complete patient records electronically on DVD in our region but are limited by the interoperabilit y of clinical software vendors.

Ironically the biggest stumbling block we currently face is “MEDICAL DIRECTOR”, their software will not import a medical records exported from any other software vendor, whereas others have interoperabilit y. I think that Medical Director and all software vendors need to turn the mirror on themselves and ask: Why doesn't their software provide the capabilities GPs want as part of their existing workflows?

“Start with the clinical problem we want solved rather than the technology we want to build”
0 # Simon James 2015-04-30 15:39
Hi Troy,

Every time I see mention of 'sending complete medical records' I reflect on the NZ GP2GP system, which does just that. Searching for that acronym on this site has many stories about the system, but without some leadership and funding from DOH (or even NEHTA if they manage to extract more $$), it's hard to imagine any progress on an agreed specification and interface will be made in this regard.


GP2GP uses a standards based toolkit and is designed to facilitate the electronic transfer of patient records between general practice.
The key benefit from GP2GP is that patient’s past medical records become fully integrated into their new practice’s current medical record for them.
GP2GP is used roughly 30,000 times each month.
GP2GP now allows patient files of up to 20 Meg in size to be successfully transferred between practices ensuring scans and attached documents are all transferred.
Even the English seem to get it and have had time left over to make a video:
0 # Troy Bailey 2015-04-30 18:10
I’m not sure we should or can rely on government anymore to deliver these system wide improvements, it appears that when government funding becomes available private enterprises are quick to gobble up all available funds without focusing on solving clinical problems. We live in a consumer based society, consumers need to demand better products or change supplier, which I believe has been happening in recent years.

Referring back to the initial article it seems clear that the slow uptake of eHealth is a result of the poor resources available to clinicians in OZ. The eHealth Record is an example of a great opportunity for system-wide improvement which was lost in the restrictive controls applied by NHETA and the less than user-friendly interface offered to clinicians by software vendors. Perhaps we should be focusing on point-to-point messaging first rather than point-to-share, this would have provided quick wins and buy-in from the sceptics.

If the 4 major software vendors in NZ can collaborate, why can’t the 4 major GP vendors in OZ?
0 # Thinus 2015-05-03 08:28
Quoting Troy Bailey:

Ironically the biggest stumbling block we currently face is “MEDICAL DIRECTOR”, their software will not import a medical records exported from any other software vendor, whereas others have interoperability.

Very true - I think their survey results were a bit disingenuous for, as you say, they are the biggest culprits in limiting electronic transfer.

Like you we send all our records via registered mail in teh form of encrypted DVDs - it is therefore sort-off correct to say we use snail mail. It is however a pain when receiving a Best Practice disc and then being unable to import it into the MD data.
0 # Jenny Nunn 2015-05-04 09:32
Quoting Thinus:
[quote name="Troy Bailey"]
Ironically the biggest stumbling block we currently face is “MEDICAL DIRECTOR”, their software will not import a medical records exported from any other software vendor, whereas others have interoperabilit y.

I agree there is a lot of disparate systems out there that also claim to designed by doctors for doctors, but still don't seem to get it right.

With releasing patient records, I've known of a system that allows interoperabilit y via secure messaging, however it relies on the recipient system to know what to do with the data, like the encrypted DVD situation. We can only wait for the others to catchup.

Another concern with mail and fax is there's loss of security. Anyone can pick up someone else's mail and fax. Patients should be alarmed.

The Government has tried to help but failed. What's next?
0 # Troy Bailey 2015-05-04 10:07
I think the first thing the decision makers need to realise is that there a multiple scenarios when it comes to communicating patient information.
1st we need point-to-point communication for referrals to primary, secondary and tertiary health services,
2nd we need patient transfers for when patients move to another GP and
3rd we need point-to-share for unexpected presentations.

This is the order of volume and priority, once this is realised eHealth funding can be distributed for maximum benefit to patients and practitioners.

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