E-Health in General Practice: a bitter pill

to swallow• Josephine Raw

• General Manager• Practice Innovation and Policy

Australian General Practice

• 25,726 General Practitioners (GPs)

• approximately 7,500 general practices

• >117.4 million GP consultations / year

• 80% of Australians visit a GP at least once per year

General Practice: Computer use• GPs lead medical community in adoption and use of

computerised systems • 96.7% practices have a computer• 53.5% have EHR (completely paperless)• 34% hybrid EHR/paper system

General Practice: History of e-health• 1998 DoHA estimate <10%

of practices use IT• Practice Incentive Payment

August 1999 as driver to increase adoption.

• Per FTE GP– $3000 = support provision of

data– $2000 = use of prescribing

software– $2000 = capacity to

send/receive data electronically

General Practice: History of e-health• e-health Practice Incentive Payment

been modified over the years to further encourage take-up

• General Practice Computing Group (GPCG) formed in 1997 through Commonwealth support

GPCG

Mission

• To improve the health and quality of life of the Australian community through the systematic introduction of more effective management of information in general practice and between general practice and other sectors of the health industry.

GPCG

Vision – to ensure that:

• the majority of GPs are at ease with the use of information technology for relevant clinical and administrative purposes; and

• the technological infrastructure enables nationally consistent linkages and uniform standards throughout the health industry.

Unique drivers for GPs

• Private business operations– small: solo – large corporate: 20+ GPs and other services

• Diversity of practice

• Demand drivers: geography, population

• “Community” focus

GP Clinical Systems

• Multiple different systems (16+)• Four (4) provide 90% of market• No compliance testing of products• Poor integration• Few standards for data:

– Collection– Recording– Measurement

Current data collections

Health Insurance Commission (MBS claims)

• “Most comprehensive” (widest coverage)

• Claims management (lacks detail) – type of service only eg. item 23 Professional attendance at consulting rooms

• Omits non fee-for-service components

• Poor collection for some populations

Other data collections

• Bettering the Evaluation & Care of Health (BEACH) study

• Australian Primary Care Collaboratives (APCC)• Pen Computing Systems Clinical Audit Tool

(CAT) – internal collection and data analysis• RACGP Clinical Health Improvement Portal

(CHIP) – external benchmarking and comparison

GP Data Governance Council• Formed September 2009• Chair: Dr Mukesh Haikerwal• Key stakeholders – all general

practice associations and groups including consumer representation.

GP Data Governance Council• Oversee the use of

any general practice data

• Establish protocols for collation, analysis and presentation of data, aligned with legislation and standards for best practice

Goals: Data Governance Council • Protect needs & interests of all data

stakeholders• Ensure integrity in use of data• Increase availability of data & information• Provide consistent approaches to management

of data and data requests• Ensure compliance with privacy legislation• Provide open and transparent processes

Achievements Data Governance• Established framework for governance of

general practice data

• Agreed a position on “Use of Data”

• Developing position on “Data Governance and Information Security”

• Work in progress on “Quality of Data” and “Privacy”

PCEHR

• General practice ideally placed to populate summary information into PCEHR (from GP summary)

• Reinforced by September meeting of the United General Practice Association, September 2010 in meeting with Minister Roxon

• Content of summary defined in the RACGP Standards for general practices (4th ed)

Standards for General PracticesOur practice incorporates health summaries into

active patient health records. Indicators►A. 90% of active patient records contain a

record of known allergies.►B. 75% of our active patient records contain a

current health summary. A satisfactory summary includes where appropriate:

C. Documented standardised clinical terminology (such as coding) to enable data collection for review of clinical practice.

A bitter pill to swallow?

• Chloroquine

– malaria prevention

– very bitter

– good for you!

• e-Health

– improves quality of care

– good for providers

– good for consumers