Complexity & Choice

The Answer

Systems Approach & Layers

Options

PMS is for the Reception, patient demographic database (names, addresses etc), and patient billing functions.

The CMS is a decision support system for doctors, basically the patient medical record and scripting, for example providing timely warnings of potential prescribing errors or conflicts.

An integrated package or integrated solution in the lingo is well worth considering. For example, Medical Spectrum, but its expensive. If you want to go cheaper, then its a case of matching a CMS with a PMS. An integrated package means that there is only one supplier to deal with all the time, and there is less likelihood of coordination problems between the PMS and CMS. The most commonly used CMS package in Australia is Medical Director. Its very good. But it does not offer a PMS function. It is often matched with Pracsoft PMS. There are numerous other PMSs that may be matched with Medical Director.

The PBS is the traditional business management function of bookkeeping/accounting, banking, wages etc.

When a patient can be called up at Reception when they enter the practice, without any paperwork needed (that is, no need to pull the paper-based patient file from the filing system); the doctor seeing that patients clinical record on their screen, being able to add new notes to it, prescribe and print a script, add pathology, radiology, specialist referral letter, and note the consultation type; Reception seeing the consultation type onscreen and seeing the amount to be paid, plus any overdue amounts; swiping the patients debit or credit card for instant payment with electronic funds transfer (EFT) immediately into the practice bank account, or, swiping the Medicare card for automatic bulk-bill voucher batching; transmitting the bulk-bill voucher electronically via modem to the HIC (Medclaims system), whereupon the HIC EFT the voucher payment directly into the practice bank account (after receipt of a physically mailed summary sheet is received). Major additions to these options are either being trialled or are expected in the next few years.

Then there is the whole subsystem of the patient database. It can be manipulated easily in electronic form compared with the paper form. This opens up the possibility of easy patient recall - for subsets of patients, eg mailing a letter about flu vaccinations to all patients over 70 years; immunisation recalls; pap smear recalls etc. A lot of the hack work involved is done by the software, so it becomes a do-able task and less of a boring chore for the admin staff.

This database is a valuable asset. Information is valuable, but only if you can massage and manipulate it. That cant be done when its locked on paper up in cumbersome manila folders in a bulging filing cabinet.

The choice, complexity and system layers make the questions too simplistic. Its case-by-case per practice. My view is that allowing others to make practice decisions is fraught with danger. For example, bulk-purchase schemes often go wrong and few are happy. Much better for the Division to raise awareness, assist where feasible, and collate resources for practices to use that assist doctors and practice staff to upskill and take ownership of IM/IT decisions. Empowerment will follow regarding IM/IT matters.

For software subsystems, the options have been well summarised by Sullivan and Nicolaides Pathology, at least for their clients who use electronic pathology download (computing_news@snp Bulletin Update brochure available from the Division).

The proposed IM/IT component of the PIP will provide the money for IM/IT upgrades. The requirement for a practice to provide (a) basic practice information, (b) electronic prescribing, (c) electronic communication, is easily met (the requirement to head toward accreditation is a bigger issue). The final outcome, although difficult in the process of attaining it, must be generally beneficial to the practice and patients. Some of you may be skeptical about this last comment, but what Ive seen of the practices that have a well-planned, sound electronic IM/IT infrastructure in place, and a sound human resource infrastructure - happy staff, leads me to that conclusion.

Y2K

What about all that compliance testing stuff, computer software and hardware stopping etc? Well, some of those problems will occur: your old 80486 computer needs a BIOS patch; your date-critical programs - the bookkeeping/accounting, money, wages programs etc need investigating - compliance information from the supplier; otherwise, your word processing program, even if it displays a bad date will still type a letter, and you probably never use the date function in it anyway [again. It is imperative however that the mission-critical aspects of your business have been audited and checked out. Any of the four subsystems of PMS, CMS, PBS, PCS that contain essential components without which the practice can not function normally need careful thought, in particular, an action plan for a work around if that component wont work from 1 January 2000.

The thing that will impact on your practice is supplies: stock up on an extra photocopier and fax toner cartridge before December, also photocopier paper. Any other consumable the practice needs. This is what you do the audit for. There has been so much hype about computers but a real hassle will be non-computer supplies. Check with your solicitor re legal risk if you cant offer every service in your practice that you normally do - after all the practice is a business like any other.

Consideration of the logistics, in-house expertise, upskilling, and IT infrastructure support required needs careful planning, recognition, and time. Under-estimating the effort required is typical and will add extra stressors when they dont need to be added, if the process is really realistically approached. Major change can bring major benefits, but the initial capital cost to the practice and stressors to humans in the practice should not be underestimated.

I hope that this article shows the scale of IM/IT infrastructure matters for general practice. It might all seem too much to consider (it does for me at times), so the do-nothing option may seem to be the only one open to us. But carpe diem - seize the day thinking is needed: dont be afraid, take a step.