| Project Objectives / Summary:
The aim was to develop a cost effective and sustainable electronic infrastructure to facilitate the transfer of secure, standardised data between GPs, Divisions of General Practice and Queensland Health. The objectives were as follows:
- To develop, in consultation with GP clinical software companies and GPs, software to facilitate the automated extraction of data from the GP's desktop application to their local Division of General Practice.
- To develop network infrastructure to enable the secure transfer of data between GPs, Divisions of General Practice and Queensland Health.
- To explore the opportunity of integrating existing General Practice databases into a standardised and updateable format.
- To provide GPs, Divisions of General Practice and Queensland Health with population health data collected by General Practitioners.
- To develop procedures within Queensland Health to provide Divisions of General Practice with regular epidemiological reports based on information collected through the network.
- To develop infrastructure towards the development of educationally grounded GP feedback systems based on information collected through the network.
- To develop formal links between Divisions of General Practice and Queensland Health's Public Health Services.
- To develop a system suitable for expansion to statewide and national levels.
Project Collaboration:
The Project was undertaken by a consortium of three Divisions (Brisbane Southside Central, Ipswich and West Moreton and Southern Queensland Rural), an SBO (QDGP) and Queensland Health, with Brisbane Southside Central Division of General Practice as the nominated fund holder.
Project Outcomes:
During the first phase of the Project, Queensland Health provided and funded a project officer. This support was additional to the amount funded by ADGP through the Innovations Pool. The FDDP Project stalled for some time whilst we have tried to work how to overcome the barriers encountered in the first phase. The main barriers were the low uptake of IM/IT by practices and the development of a suitable data recording and extraction process. A summary of the identified barriers is attached.
In May 2001 Queensland Health withdrew from the Project and the initial Project Officer was lost to the Project. Through August and September 2001 the project plan was re-written and submitted to the ADGP and initially accepted. Subsequent discussion raised the questions as to how the project was still innovative and did the budget allocation need to be reviewed.
The Project was subsequently terminated by the ADGP on 19 November 2001.
Barriers to Project Development and Implementation
GP Recruitment
The issues discussed below have contributed to decreasing the sample population and hence the limited numbers of GP's recruited to date.
- The level of computerisation of general practitioners - the data collected nationally and statewide indicated a high level of computerisation of GP's. This figure is misleading as the utilisation of all aspects of clinical software is poorly reported due to the different methods of data collection.
- The use of the clinical records component of the applications - whilst GP's have computers and many use them for scripting and pathology, many do not use the clinical records section of the application to it?s maximum advantage. Of those GP's statewide, we have estimated approximately a 10-15% utilisation of the clinical records section of the medical software application.
- Inconsistency in use of clinical records component - some GP's report they use the clinical records component of the application, however, they may not use it for all patients and if they are busy they may write some notes and record some in their clinical software application. Inconsistency in the documentation methods prevents the collection of valid surveillance data.
- GP's not understanding the identified benefits to themselves, the practice and patients - discussion amongst the GP reference committee representatives and GP's in the pilot divisions has found that the benefits we identified are not perceived to be benefits by the GP's. The following points explain these in more detail.
- No financial incentive - payment for connection to ISP or subsidy for current ISP is seen as a "token" payment for participation. Some GP's feel that a financial incentive should be paid to them for accurate documentation and extraction of data. Reasons expressed are discussion with patients about project, practice staff involvement, potential IT problems.
- Disinterest and lack of understanding of population health activities - some GP's have expressed a disinterest in their contribution to population health activity. The information collected at a practice level is essential for the understanding of the burden of disease. Many GP's do not see that participating in a population health activity will in turn benefit their patient at a practice level and contribute to overall population health.
- Time for training in medical software applications - GP's are mildly interested in training, however, they express a lack of time to upskill and may require financial incentive to participate. This barrier needs to be considered outside of this project if future health activities are to be electronically based.
- Time to meet to discuss project - personally meeting with a number of GP's within one practice, and individually, has been difficult due to time constraints.
- Current network infrastructure - some systems are very advanced whilst others lack the capacity to ensure reliability in data transfer. Whilst these GP's may be interested to participate, their system may require upgrade which will cost them. The project is not funding the practice network infrastructure.
- Fear of loss of data - GP's have expressed concern over the possibility of the extraction and transfer software corrupting their current system, corrupting or deleting their files. The time involved to retrieve this data, if caused by the software, is a potential financial burden to the GP/practice and ultimately the project.
- Security and confidentiality - whilst many GP's have an internet connection within the practice they appear to use a dial up access rather than permanent connection. There is a fear of viruses and hacking related to the internet/email and especially in instances where patient data, albeit de-identified is to be transferred.
- Media - one of the key stakeholders we are negotiating with have recently been quoted regarding a project they are conducting in relation to the on-selling of de-identified patient data to the pharmaceutical industry. This has major implications for this project in light of the points discussed previously.
Software Industry
A: Medical Software Applications
- Requests from other organisations to integrate data fields for surveillance activities into applications - the key companies have expressed that many organisations have requested adaptation of their application and development of extraction software. The issues for the companies are the inconsistencies in the required models and the lack of a national consensus for data fields considering the applications are used nationally.
- Different definitions of disease and data fields across competing organisations - it is widely recognised that case definitions differ across surveillance activities and that comparability is not possible due to this. The companies have stated that the case definitions need to be the same for each activity in order to meet the specific coding systems integrated within the application for disease classification eg. ICPC 2, Docle and ICD 10-AM.
- Upgrades of Medical Director - if the extraction tool is developed by HCN, then each quarterly upgrade will need to consider the FDDP extraction process. GP?s have expressed dissatisfaction with the current upgrade process from HCN, specifically their system "crashing" following the installation of the upgrade.
- Costs for development - initially the companies indicated a no cost to development, as investigations have continued and the issues described above have emerged, there has been discussion about cost for development.
B: Development of extraction tool
- Unable to proceed until commitment from companies to develop application as we require specifically for this project or consensus amongst competing organisations.
- Costs for development - initially the companies indicated a no cost to development, as investigations have continued and the issues described above have emerged, there has been discussion about cost for development.
- Timeline for development - no commitment to timeline if there is no payment for development, payment needs to be considered to ensure a commitment to project timeframe.
Email: info@bscdgp.com.au
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