Andrew Binns
The Help Desk
Computing Columns
Lecture Notes
General Practice Computing
Barriers to Computerisation
IM/IT and all that - a personal view
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Last Modified 2/8/99
No more than writing while consulting. With improving typing skills and efficiencies with things like repeat scripts, ultimately we should be able to increase eye to eye contact with our patients.
What about accessibility to support?
This is certainly an issue and we should never imagine that once we have bought the computer and installed the software that all will be well. Crashes are inevitable and backups should be well planned and funded as an ongoing cost.
What about loss of data and the medico-legal implications of this? How long does it take to upskill users?
People pick up the skills surprisingly quickly, but it is essential to provide staff and doctors with appropriate training. Divisions will have an important role to play with this training and there is now some quite generous funding available for divisions for this purpose.
How secure is the system?
If anything, computerised medical records are more secure than paper records. Access barriers such as passwords protect computerised medical records. With a doctor's comments on pathology reports accessed by computer, staff can only see the doctor's comment rather than the whole report, which improves confidentiality concerns.
What about cost?
Computers are expensive to buy and maintain and it is important to see the value in financial terms as well as the other benefits before taking the plunge.
Assuming the equipment needs replacing every three years (sorry you won't do better than this) the capital cost per year per doctor for the hardware and software is about $3,500 for a $10,000 system. Then add the cost of the vitally important support, maintenance and development needs, which is about another $3,000 per doctor per year. This brings the cost to a total of about $6,500 per doctor per year. There may be dangers in thinking these figures can be beaten by much. The system must work all the time!
Suppose a GP writes all scripts, referrals, letters and certificates on computer, plus has desk access to all medical records, path test results, specialist reports and so on, there will be a saving of at least 15 minutes a day of his/her time. Assuming a four day working week this amounts to one hour saved a week. Assume we are worth a conservative $100 an hour this is a saving of about $5,000 a year. This is a very conservative estimate. With time and experience the efficiencies are likely to be much more.
(b) Staff cost savings
Suppose there are networked computers on all doctors' and staff desks with resulting minimal pulling of files, easy access to pathology results (from the front desk), easy access to accounting, booking program and data base with resulting savings of 30 minutes a day per staff member paid at $14 an hour. This will result in savings of $7 a day or about $2,200 per year.
Total savings for practice will therefore be at least $7,200 per year.
Barriers to computerisation
There are many good reasons why some doctors may decide not to bring computers into their consulting rooms. Technophobia is an obvious one and those of us who have trouble with all things digital will certainly think twice about the stress of giving it a go. However, software designers are well aware of our fears and have actually made the programs for people like us. It is really not too difficult to master the basics of modern medical programs, which are very user friendly.
Some commonly asked questions
Are computers in the consulting room a barrier to communication?
Backup systems need to be of the highest standards to avoid these catastrophes. The good news is that with modern equipment and expertise this problem can be managed in such a way that risk of losing data is minimised. Paper files also can be lost.
The cost
Whilst there are many ifs and buts and opinions on cost, the following is offered as a guide based on the experience of the Goonellabah Medical Centre, which is well advanced in the move towards a paperless system and has used computers on all desks for two and a half years.
Justifying the cost
There are two ways to justify this significant practice expense:
1. Cost savings
(a) Doctors' cost savings
2. Government assistance through PIP
The information management/ technology element of the PIP provides $10,000 in year one and $7,000 in each of years two and three per doctor, providing the computer can write prescriptions and has modem connections with internet access.
The bottom line
With savings worth about $7,000 and incentives of $10,000 in the first year as opposed to expenses of around $6,500 per doctor, it is hard to justify not acting to computerise. The take home message is pluck up the courage, look around for the best system (not the cheapest) that will do the job and go for it.
Andrew Binns is a GP in Goonellabah and still considers himself a computer drongo.
Discussion
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