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Ask Dr Dave

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Last Modified 1/2/99

Dear Dr Dave
I see 60 patients a day. I know them well and can remember most of their important medical problems. I cannot type and using a computer would slow me down. Where is the evidence that computers are cost effective?
Sceptical

Dear Sceptical
A common complaint is that medical practitioners cop all the expense of computerising and everybody else gets the benefits (readable scripts, fewer drug interactions, better access to general and patient specific medical data, etc., etc.). The start up costs are significant as well as the opportunity costs for the practitioner and the pay back time may be more than two years, which is the time interval often used in business for investment in new plant.

It is doubtful that you can sack a secretary, but you might find their time is spent in more useful ways than filing and looking for lost reports. They will love the computer once comfortable with how to use it and your new business and computer systems have stabilised.

Some bulk billing surgeries have made a mint out of fully computerising their practices. They can service five to ten doctors with only one or two receptionists and can drive their costs down towards 10% of their income. In this era of frozen rebates it will be the only way bulk billing practices can survive. Who says the government doesn't support GP computerisation?
DD

Dear Dr Dave
I have had a computer at home for years and was one of the first to own an Apple IIe. We use a computer for accounts at the surgery and I guess it is OK but it has not changed my life. Networks seem to me to be very complicated and expensive and I don't see how they will help?
Stan Dalone Dear Stan
If you are going to get any benefits from computers you will have to network the one on your desk with at least one other and you will also have to access data outside your surgery. You do not have time to enter patient demographics or any other details from the paper record and neither does your secretary.

Your billing package will capture these and transfer them to the clinical package. Pathology results can now be downloaded from two of the pathology companies in the area and the third has installed software to do this in the New Year. It is hoped that radiology reports from the NRAHS will be available mid year.

This leaves private radiology and letters to be incorporated into your database. These narrative style reports can be readily converted to computer text using modern scanners and optical character recognition (OCR) programs. Encourage your limited practitioner colleagues to use A4 and Times New Roman 12 or bigger. If they send you anything handwritten, let them know you appreciate their skill in this ancient craft but will be unable to send them any patients in the future.

The last hurdle to be crossed is your own hand written notes. Modern packages let you select options from a variety of pick lists for drugs, diagnoses, pathology and radiology. Even more helpful is the option to use your own abbreviations for common terms. It is nice to see 'peccrla' converted to 'pupils, equal, circular, concentric and reacting to light and accommodation' in 10 milliseconds. You can even set up your own mini-templates for common history items and examination findings.

Still, for simple things, you will probably find it quickest just to type in a line or two. So, if you cannot type, I recommend you try Dr Dave's two step plan to fast, accurate typing:

1. Sit down with Mavis Beacon for six hours and just learn to hit the right keys with the right fingers.
2. Get hooked on the internet and hack away.

A more detailed discussion of the merits, mechanics and options for networking a GP surgery can be found at http://www.pracsoft.com/focus_networks.htm
David Guest
www.MedicineAu.net.au/Cards/DavidGuest