$$ - An introduction to specialist computing
This article is the first in a series that will seek to draw attention to the importance and potential of specialist computing. This instalment serves to map out the themes that will be canvassed throughout the series by highlighting some of the unique computing challenges and opportunities specialists face in their private practice setting.
For the purposes of this introductory article, no attempt has been made to differentiate between the needs and nuances of the various specialties i.e. all participants in the secondary care market have been treated as a homogeneous collective. Future articles in this series will highlight the different IT requirements of procedural and non-procedural specialists, and indeed, draw attention to some of the unique requirements of individual specialties.
Incentives To Computerise
While there has been a long running push to improve levels of computerisation in private practice, to date, much of this attention has been directed at general practice. As a consequence, general practice is now relatively well computerised, however adoption of information technology by private specialist practice has been less impressive.
The recent Australian General Practice Network (AGPN) budget submission has highlighted the importance of improving the level of information technology uptake by non-GP health professionals. Focussing on the purported need for more effective team based primary care, the AGPN has requested that $25 million funds be directed to allied health professionals to assist with the purchase of hardware and clinical software.
While the AGPN is not jurisdictionally bound or resourced to drive the adoption of information technology in the secondary care space, the justification presented by the AGPN in its pitch to the Treasurer to support the rollout of information technology in the allied health sector applies equally well to specialist practice. That is, improving the level of computerisation in the secondary care sector will benefit both the clinicians who adopt information technology, as well as their colleagues with whom they routinely correspond.
Unlike general practice, specialist practice has not enjoyed any significant direct financial subsidies from Government to computerise, nor have they enjoyed technical support and assistance from an over arching Government funded Division-like network.
While it may be successfully argued that the high earning capacity many specialists enjoy would limit the effectiveness of IT related Practice Incentive Program (PIP) style incentives for specialists, the author is of the belief that this should not preclude the secondary care market from receiving resources and training to assist with the adoption of information technology.
That said, with information technology permeating into all aspects of modern society, it may be that the motivation for some specialists to computerise may come from entirely non-medical influences. Indeed, specialists who have previously had little exposure or interest in computers may be attracted to increasingly accessible main-stream technology applications such as online banking and share trading, digital photography, online music and movie downloads, Internet telephony, and even computer games.
From a computing perspective, there are several similarities between the needs of specialists and GPs. Indeed, many of the software packages originally pitched at general practice are now also sold in configurations for specialist practice. In addition, most hardware and associated peripherals are equally suited to both specialist and general practice.
Despite the commonality in their software and hardware options, the fundamental differences between the way that GPs and specialists practice medicine dictates that the way GPs and specialists interact with their information technology will also be different.
Following is an introductory overview of some of the IT related aspects of specialist practice that will be discussed in detail during the course of this series.
Referrals and Scanning
Referrals, and letters back to referrers, drive the IT workflow in specialist practice. Because of the importance of these documents, practice software designed for specialists tends to have a strong focus on document generation, storage and management.
High capacity document scanners suitable for general and specialist practice have fallen in price, and have greatly improved in quality in recent years. Perhaps more importantly, the software that drives these devices has also improved, as have the clinical document storage options available to specialist practice.
Suitable document scanners and the scanning and document management functionality of various practice software solutions will be reviewed in the May 2008 edition of Pulse+IT.
Typing and Dictation
Stemming from the predominantly letter-based patient record system used by specialists, the combination of dictaphones and medical typists (either in-house, or outsourced) is often found in specialist practice.
This clinical note-taking and document generation workflow can be contrasted with that of GPs while a regrettably high number of GPs still record their clinical notes on paper, GPs that do keep electronic health records tend to input their notes directly into their clinical system themselves.
The various medical typing services, and the way popular specialist clinical software integrates with these services, will be discussed in the November 2008 edition of Pulse+IT.
On the back of ever increasing computer processing power, voice recognition technology has matured rapidly in the past few years. While it is certainly not a flawless technology, it is being used successfully as an effective primary input technology by specialists interested in generating their own reports without the assistance of a typist or typing service.
Suitable microphone options and voice recognition software, for both Windows and MacOS X, will be previewed in the November 2008 edition of Pulse+IT.
Secure Electronic Messaging
The entire health sector is rapidly becoming aware of the burden placed on recipients of paper documents. While scanning can overcome physical storage issues, it is unavoidably a labour intensive process that consumes hundreds of hours worth of time per year in a typical paperless practice.
While many specialists place great emphasis on the physical presentation of their letters, the GP sector is becoming more vocal about the benefits that the electronic receipt of clinical documents delivers.
In addition to providing their referrers with a valued service, secure clinical messaging allows specialist practices to benefit from reduced paper handling and postage costs. Further, as more GPs adopt secure messaging solutions and electronic referral rates begin to rise, specialist practice also stands to benefit from a reduction in incoming clinical paper correspondence.
While significant coverage of secure messaging was presented in all editions of Pulse+IT throughout 2007, an article focussing on secure messaging from the perspective of specialist practice will be included in the August 2008 edition of Pulse+IT.
Recent improvements in the bandwidth of both cabled and wireless broadband solutions means that specialists now have access to technology that provides the ability for them to view and transmit clinical images over the Internet.
In the wider digital clinical imaging context, the importance of standards are being promoted by the recently formed Australian chapter of Integrating the Healthcare Enterprise (IHE). The activities of this group and the potential impact of their work on the secondary care sector will be highlighted in the August 2008 edition of Pulse+IT. This edition will also include coverage of the various digital clinical imaging distribution solutions available on the market.
Specialists typically spend less time tethered to a single location than their GP colleagues. As a result, IT systems designed for specialists need to be able to function seamlessly from multiple, geographically dispersed locations.
Access to both clinical and billing data can be facilitated using either remote access solutions, or by physically transporting practice data to the various sites of service.
Largely driven by improvements in software technology and Internet bandwidth, the establishment of a secure connection from a remote location to a specialists base practice is now a relatively straight forward undertaking. The dramatic improvements in mobile wireless broadband technology, and the burgeoning ultra-portable laptop and slate tablet markets provide specialists with a wide variety of portable computing options.
A comparison of the various remote access software solutions will be featured in the May 2008 edition of Pulse+IT. This edition will also feature a comparative review of various mobile broadband solutions, in addition to a separate discussion about the rising popularity of ultra-portable laptops and slate tablet devices.
Stemming from the fact that many specialists work from multiple locations, sometimes under complex cyclical arrangements, specialist practices usually have more specific requirements for their electronic appointment systems than their GP colleagues.
Given the limited availability of doctors within many specialties, it is not uncommon for appointments to be booked months in advance of the scheduled encounter. Due to the high commercial value placed on specialists time, the importance of patients presenting for their scheduled appointments with a valid referral cannot be overstated.
While a busy GP may relish the occasional no-show, the failure of a patient to present for a scheduled procedure is likely to impose a significant opportunity cost on a specialist.
Technological solutions such as SMS and email can help to minimise patient no shows without placing additional burden on administrative staff.
The August 2008 edition of Pulse+IT will feature an in-depth comparison of the various appointment systems available to specialist practice, including a discussion of how these appointment systems interact with SMS and email reminder functions.
This article has presented an overview of a forthcoming series on specialist computing aimed at demonstrating some of the practical benefits information technology can deliver to specialist practice.
Throughout the course of the research and construction of this series, input from specialists, their practice managers and their support staff will be warmly received by the author.
Posted in Australian eHealth