News
Ask Dr Dave
Ask Dr Dave - August 1998
Unconnected.
Dear Unconnected Computers are only useful if they allow you to do your work quicker or better. Fifteen years ago computers could only access information that the user typed in or inserted on a floppy disc. Over the years other input devices have become available, such as mice, CD-ROMs, DVDs, streaming tape, removable hard drives and voice recognition. The trouble with all these gadgets is that they are fairly labour intensive and too fiddly for the GP with a waiting room full of flu.
The GP needs to find the patient's file, record her notes and write a letter or script using only a few key strokes. To achieve this you need to have someone else do the hack work and then you need to access that work. For the busy GP this is the main advantage of a local area network (LAN). It is a sophisticated, labour saving input device.
The nuts and bolts of the LAN are easy. Each computer has a network interface card (NIC) that fits into the back of the computer. It connects to the other computers by a wire. Usually one of the computers on the LAN is designated the "file server" and it stores all the information. The other computers get the information about the patient from this machine and any new information they create is sent to it. Most modern networks have a star topology where each computer has a direct connection to the server via a small piece of computer equipment called a "hub". It might sound a bit complicated, but these days network capability is standard for almost all GP billing, scheduling and patient management software.
The next step is to connect your network to other networks via the telephone system. This will allow you to benefit from the work that others outside your surgery have done and also allows others to benefit from your work. The protocols and software required to make this happen are still in their infancy. It will be quite some time before they become mainstream, possibly as long as two years.
Dr Dave
Dear Dr Dave I was pleased to see my immunisation percentages were in the high eighties when the first batch of figures came out from the ACIR. Then the government announced that it was going to pay me a bonus if the vast majority of my patients received all of their five year old immunisations. Now my lastest set of ACIR figures have gone down to the low 60s. It seems to me that the government is manipulating the numbers. Am I just too suspicious?
Tantalus
Dear Tantalus The Australian Childhood Immunisation Register has done a tremendous amount of work over the last few years. It has been continuously refining its practices and procedures to improve the quality of data that it holds. It is these changes that account for most of the variability in the figures.
Part of the problem for GPs is the lack of transparency in how the figures are calculated. Often you cannot recall ever seeing the patients listed on your feedback sheets. You usually have, however, although it is may have been only once. Neither you nor they regard you as their usual GP. Nevertheless, they affect your percentages.
To address this problem some favour a linkage system whereby patients are assigned to a particular doctor or medical practice. This is the system used in England and some European countries but there has been no widespread support for it Australia. The recent General Practice Strategy Review had a bet each way on this issue. It stated:
a. that the introduction of compulsory patient linkage at this time is not supported; (Recommendation 13)
b. that the proposed General Practice Partnership Advisory Council, which includes consumers, further investigate voluntary patient linkage to practices (Recommendation 14).
This sounds to me like the patients were opposed, the doctors indifferent and the government all fired up to get it going.
It seems unlikely that GPs will ever make their fortune from the ACIR or the PIP or the methadone program or any other community health program. My advice to young GPs is "Don't give up your day job!"
Dr Dave
Dear Dr Dave The phone authority system is a disgrace. It is a complete waste of time. Why should I have to ring up some junior clerk in Canberra, repeat some wording parrot-fashion and fill out yet another piece of bureaucratic paper?
Disgruntled
Dear Disgruntled Money. Since you do not pay for the medications yourself, you bear no personal cost for what you prescribe. The government counters this through the phone authority system. If a GP wishes to use a more expensive medicine, she is forced to use up one of her most valuable resources, her time. The recent extension of the phone authority system to therapeutic group premium drugs is an indication that the scheme has been successful. But look on the bright side. If it weren't for the phone authority system we might have budget holding for pharmaceuticals.
You can of course get around most of these hassles by using the computer for prescribing and I quite enjoy doing authority scripts these days. The patient's Medicare number, your prescriber number and the mantra all appear on the screen in front of you. It is one of the few times during the day when you can sit back and relax, listen to the musak or converse sociably with the patient. It can turn a standard consultation into a long one and, best of all, just the sound of John's voice brightens my day.
Dr Dave
David Guest, dguest@om.com.au
Discussion
|
Return to top of page This page was last built on 24/5/99; 9:46:17 AM. It was originally posted on 30/8/98; 9:04:04 PM. Webmaster:  lemlink@medicineau.net.au |
 |
Index |  |
Ask Dr Dave - April 1998 |
MedicineAu