GPs must drive e-health records process
By Dr Sam Heard
AS a senior GP, a director of the openEHR Foundation* and CEO of a software company working to enable shared electronic health records, I want to share my thoughts on the role of clinicians in the rapidly developing e-health environment. I want GPs, as well as practising generalist physicians, to take a key role in the design of their future health records.The Federal Government’s agenda for the introduction of electronic health records (EHRs) is broadly aligned with international efforts to harness technology to improve healthcare. Suddenly the information we record during consultations is being seen as the key asset for improving healthcare.
The sharing of summary and consultation data, medication lists and laboratory and radiology results may well change the face of healthcare. However, clinicians around the world are largely excluded from these advances, due to the technical nature of the solutions offered. But this is largely our record of care.
Some may say, “We can keep the record of care locally and share bits and pieces as required.” This may seem wise at the moment. But people move, they seek care from a range of GPs and other practitioners, they go to hospital, and they get serious conditions requiring extended care involving a number of specialists and healthcare facilities. It doesn’t take long to realise that the shared record will soon be the master record and our local record the minor record of care.
This new shared record must work for the clinicians. If not, then it is not a health record and should be called something else. So how do we get involved and not leave it to computer scientists?
First, we must involve the professional colleges, who have the role of setting standards for quality and safety in healthcare and need to govern the specifications of the data that will be shared in a lifelong health record. This process will ideally start with the RACGP, as most of the data shared initially will arise from general practice. All the better if this can be done over the internet with input from those with skills and interest, but without having to be in demanding and expensive face-to-face meetings.
This work must be supported by the Federal Government, as it will ensure that the shared health record provides the computational power that is sought for decision support, reporting and complex event processing. Other stakeholders need the resources to enable them to be involved.
Defining clinical content is an ongoing task but the collective effort will save a truly massive amount of resources; currently this process is undertaken by every software developer, hospital system administrator, messaging technician and form designer, over and over again.
The openEHR Foundation has developed a means for clinicians and other experts to work together to develop these data standards.
Further, two of the three Australian entities that the Department of Health and Ageing has chosen to lead the introduction of person-controlled EHR — North Brisbane and Melbourne East divisions of general practice — already use the openEHR specifications.
This approach has been designed to “put clinicians in the driving seat” and the college committees and others can collaborate to develop the appropriate standards.
If we shrink away from leading this process, the very heart of our practice could become the remit of a multinational company or government agency. This is about claiming and sustaining professionalism. It is about what is in the records of care of our patients, and it matters a great deal to the quality and safety of the care we provide.
Dr Heard is a GP in Darwin and chairman of NT General Practice Education. He is also CEO of Ocean Informatics, an Australian health informatics company, and honorary senior research fellow at University College London.
*The openEHR Foundation is an international not-for-profit organisation working towards interoperable, lifelong electronic health records. See: www.openehr.org/ knowledge
Published in Australian Doctor, 21, September 2010