I see general practice as a technology wasteland. The problem is that while many useful technologies exist, these are neither designed to work in nor priced for general practice. Since the electrical rhythm of the heart was first recorded at St Bartholomew’s hospital in 1872 and the subsequent development of the ECG machine, there has been little in the way of major technology uptake in general practice. There are some notable exceptions; the spirometer is used reasonably often while clinic-based blood sugar, INR and SO2 measurements are definitely very useful and very affordable. Yet while individual patients regularly invest in these laboratory technologies, many practices do not.
The obvious example of a technology suitable for general practice is the ultrasound. First, it is a visual tool and can be seen by the doctor and patient. Second, real time imaging is essential for interpretation. Third, it both requires and enables maintenance of anatomical knowledge which is itself useful for primary care doctors. Finally, it is a massive convenience for our patients if we can exclude an intrauterine death, see an intrauterine pregnancy, look for subcutaneous foreign bodies or drainable collections, do guided injections and the like. It is so obvious that this will be a key technology for GPs – it is safe, not expensive and provides value for patients who can also see what is going on. We need to work with companies developing ultrasound equipment to get it right for our setting. This will not displace radiologists but extends a service and convenience for our patients.
I do not want to decide which technologies might be taken up by GPs. There are so many to choose from. I would like our College to support the adaption of useful technologies for use in general practice, assist those wanting to pioneer use and then be custodian for the knowledge and skills-base required to implement the technology successfully for the benefit of our patients. This might be a useful app on a smart phone or a complex integrated fibre optic camera to view places difficult to see! Only our imagination will limit the possibilities.
Let the dance begin. The RACGP is the rightful facilitator and custodian of these endeavours.
You may know me from my work in eHealth. I have been interested in discovery around ways for clinicians to control and develop the content specification for eHealth. It was a key role of the Royal Australian College of General Practitioners (RACGP) in the days of paper to offer quality health records for use in general practice. Technology has offered a lot to our profession, particularly in managing work flow and the movement of documents. However at current levels of eHealth provision, we have lost the ability to store information in a recoverable (or query-enabled) form in a way that meets our clinical needs. This is not unexpected and many are content enough with current software to tolerate this situation. I am not. I established Ocean Informatics with 4 GP Colleagues in 1996, ws CEO from 2004 to 2012 and now chair the Board of this clinically oriented health informatics company.
My aims have been to:
Ensure that data collection specifications are managed by clinicians for specific purposes – not software developers
That standardisation of clinical information enables interoperability of care environments, supporting clinical care
That the infrastructure of eHealth should have no concern as to the content of the health records
That there should be one logical record for every person although the information may be distributed among many systems
That the infrastructure should not determine the information flows
I was a founding Co-Chair of the International HL7 EHR Technical Committee, and Co-Chair of the Standards Australia Working Group as well as the Australian delegate to the European Union’s eHealth Standards Committe (CEN TC251). My work has led to the establishment of the openEHR Foundation of which I am Chair. This international group is still evolving – this open source specification is now used in a number of European countries and Brazil. The openEHR method provides the basis for NEHTA’s Clinical Knowledge Manager.
The solutions in eHealth must involve and support clinicians. Not involvement in some glacial consultation process once per decade (if we are lucky) but in a vibrant living evolution of clinical data specifications. I believe that our College could be the curator of such an environment.