Participating in online medical discussion lists has resulted in some interesting debates. Most recently I've been involved in the discussion on the gpcg_talk mailing list regarding the value of medical records and the right to ownership of information. Certain individuals have proposed various models where ownership of the information within the medical record no longer belongs to the primary carer. Furthermore, online shared medical records have been discussed.
There will be certain circumstances where an online shared medical record has clear benefits. However there is little benefit toe either patient or carers as yet other than suplementing / extending care from the team for the vast majority.
The role of the patient in building the medical record however can be enhanced.
This is my response to one of the issues raised regarding the role of the patient.
I agree that the patient should be part of the team.
Patient care is enhanced when the patient takes onboard advice , education and assumes the role of an advocate for their own care.
We as care providers facilitate patient enrolment in their own care.
I believe that we need a new model but something that is radically different to any shared care model proposed to date.
Something that in fact promotes preventive care and enhances the role of the GP and the value of the GP's medical records.
Something along the lines of automated data collection using the most underutilised resource - the patient , or more specifically the patients time spent in the waiting room.
This is not a model that eschews of technology or requires vast sums of money invested in infrastructure or even building up vast teams of carers.
In this model, all outstanding/missing/out-of-date data is collected from the patient while they are waiting room.
Patients update family history, allergies, smoking and alcohol history, missing immunisations and other clinical data while waiting.
Patients can measure their own weight, height , waist , take an automated BP (using the same type of device as used in pharmacies), pee in a jar if required, be directed to the practice nurse if required.
All collated information is passed to the consulting doctor at the beginning of consultation.
Only data that is required to be collected to keep records up to date is actually presented to the patient for completion pre-consultation.
The Potential to collect triage information is also there.
Thus we see all required preventive care information is updated and the physician reviews information during consultation without having to spend time collating the information.
Analysis of Cost to implement.
Set of weight scales $100
Stadiometer $70
Tape Measure $10
Urine dipsticks (GP or nurse to read).
Paper to print on negligible?
Software - I write the stuff so cost is ZIP.
Automated BP machine (of the type you poke your arm in and press a button ) ??? $200 - $1000 (I haven’t purchased an advanced model as yet).
Implementation requirement.
Software to print out individualised patient data collection sheets/instructions.
Secretary prints a sheet for each patient when they arrive and directs them to the set of scales etc
Software can also prompt for immunisations/EPC items/provide prompts on targets and patient specific identified health issues.
Patient can read and follow instructions and be stable on feet to take measurements.
Ok. Take a step back.
Where is the government in this. Nowhere.
Where is online shared records. Nowhere. Yet.
Where is the patient in this. At the CENTRE.
Where is the GP in this. At the CENTRE.
Who gets value from this. GP and Patient Certainly. Government - getting more value for health dollars spent. Health teams get more updated information and no doubt better information via patients records. With up-to-date preventive care information a new horizon in preventive care becomes available and there is greater satisfaction for us as carers knowing that we are better able to assess and manage our patients.
Potential Drawbacks.
Cost of printing a sheet of paper per patient.
Potential for patients to find it a burden/intrusive.
Is it Possible?
Yes!
I do it now!
Dr Oliver Frank has tested it.
Many others using the DCP are experimenting with it or implementing systems around it.
To me any online component of a health record is a way to further extend the reach of care by the team.
To ensure value for team and patient we need to establish what will benefit both and be achievable.
But, we first need better recording within our existing software and better integrated communication facilities with other stake holders. This is a priority that dwarfs any requirement for online repositories.
Anton