What improvement would you most like to see to GP systems

Not sure what you mean by that question Deb. If you're referring to the information systems that GPs use.... People, aka patients, already use a suite of communication tools to keep in touch with one another. I think of my recent experience when visiting my technophobic 80-year-old mother in South Africa. I was in touch with friends, family and colleagues all over the world using my laptop and mobile phone. I used Facebook, texting, talking on the phone and email to keep in touch while away from New Zealand.
What I couldn't do was keep in touch with a GP for my mother's health issues. Simple things like booking an appointment, or asking a direct 'yes/no' question couldn't be done, or just text 'thank you' to her when she solved what seemed to her a small problem but had a big impact on us. I had to make a phone call, wait on automatic hold, talk to the wrong person, wait for a reply call - all to make an appointment for a house call! The same applies here in New Zealand.
If people can keep in touch with all the other people we know, how about extending that to the patient-GP relationship?

Interesting point Karen and a very important one too. Yes in the empathetic impulse to improve the situation I was tempted to suggest some new technology, but then I looked back and asked myself - how can we ensure that the GPs would respond positively and quickly if they had an access to better communication technology? Is it not the issue of time availability, keenness and attitude to be responsive? The existing technology itself should be enough to make communication possible if the doctors had the time and the will to comply.  
I remembered a story from Arabia, which says "One late evening wise man Mulla Nasir was looking for a lost ring under the lamp post, his friend who was passing by asked Mulla: "is your ring lost somewhere here?" Mulla said no, the ring was lost in the barn but it was all dark there, it is brighter here so I am searching for it in the light...!!
Reflecting back... wouldn't it be more fruitful to look where actual darkness may be and discover ways to share workload/ responsibility of providers that creates space for them to respond and encourage an environment of consumer oriented behaviour in healthcare services?

You're right, Priyesh, about not needing to invent new technology for patients and their healthcare providers to keep in touch. What we need to do is think about it sensibly and simply. As a first step, to avoid looking for the answers in the wrong places, it may be useful for people interested in this kind of thing to start talking together and gain a shared understanding of what can be done at low cost, with low effort and high impact.

Well there are a couple of issues here.
One is that email is not regarded as a secure method for health information.  While it is unlikely anyone want to skim the mail servers for confidential information, it is deemed a risk we should not take.  I make individual agreements with patients about email contact, and get verbal agreement that they ackowledge it is not regarded as secure.  Personally, i find email works very well, it is asynchronous, so I can choose my own time, it also tends to be single questions, unlike the phone where the discussion can escalate and gtake more time.  it is also a new servoce, so i often charge for the more complex emails.  The thing is , most GPs see it as a risk and think they will end up taking more time, not less.
Of course, as i've mentioned eleshere on this site, metech have their patient portal, managmyhealth, which addresses the security issue.  This will be rolled out widely and I belive will become the defacto patient health record in NZ.  Time will tell if I'm right on this.  Check out www.managemyhealth.co.nz
 
What would I like in my PMS?  Better audit tools to audit my practice population and compare my practice with others locally and nationally. Apart from that I'm pretty happy with what I have.  there are alwys fixes and improvements to any software to be made, but the biggie to my mind is audit.
 
R

Hi Richard, 
Could you describe what you mean by "better tools to audit my practice population". 
Cheers,
Michelle 

At the moment I have 4 ways of getting information on how I'm doing with my population.
1) Paper or emailed reports from my PHO/MSO with reports for me as an individual and as a practice on a number of issues . (PMP, lab ordering, pharms..)
2) paper reports from BPAC on labs and pharms.
3) Some tools built from 3rd parties (MSD, HealthStat and Primary IT) which can pull data from my PMS to give data.
4) Build my own medtech queries.
At the moment none are ideal.  What I want is access to a tool that can pull down multiple quereis on many aspects of pateint care, and present them in a compelling way and can compare with my peers.   Needs to xover muliptlea reas (prescribing, imms, financials, demographics...)  It also needs to be flexible enough for me to build a query and present that data easily without having to export to excel for tidying up.
It is coming, but it's slow.  We're well behind what UK drs are getting at the moment.  I'm speaking from the perspective of my PMS, it may well be that others doa  better job than this.  I'm aware Medetch is doing work in this area, and will no doubt be qguieded by the qi4gp project.

Hi Richard.  We're doing exactly what you describe in both Northland and Wanganui (separately) across all GPs.  Each GP gets a report comparing a number of key population health indicators for their patients against other GPs in the area.
We're using DrInfo to extract information monthly from each practice and then providing the reports.  In Wanganui all of the GPs have agreed to share their information with each other on an identifiable basis whereas in Northland the reports will be anonymised (although of course each GP will know which data is theirs).  With data going right down to GP level (as opposed to a practice) it is likely to be very powerful.
We kicked off the process by agreeing on a bunch of population health indicators, how they would be measured,what information we would need to consistently record, and what tools we would use to facilitate this.
Whilst we are in early stages the reporting appears to be very powerful and well liked.

Whichever method you use, you will first need to get agreement across all those who you want to compare yourself with around what should be measured and how.  This is no small exercise!
To quote the most often used example, we can all largely agree that you should know whether your patient's smoke.  Agreeing on how to record this is much harder though.  Then you have to ask "can we agree on the intervention that we should then provide to patients who smoke" and how to measure that... and so on.  You need to do this for each of the major population health goals, assuming you can even agree on what they are!
In Northland, this came out of the frustration of all the "ways" you mention above - expressed as the desire to have "standardised reporting" that we could all agree on.  Clearly you can't compare yourself within anyone else unless you are comparing apples with apples.
But yes, I agree that we have had little leadership from PMS vendors in this space, but where should the leadership come from?  Probably not the vendors.  GPs themselves should provide the leadership in this space (and thus bless the qi4gp project).  Again to quote Northland (and Wanganui), the leadership has come from the GPs supported by their PHOs.  The challenge is then to get the vendors to respond.

Hi Ken
You are right that we as GPs haven't been able to produce a coherent national request to our vendors, and you are also right that qi4gp will hopefully lead this soon.  I think your demonstration of what you are doing well in Northland and Wanganui,  shows that there are lots of PHOs doing clever innovative stuff.  This is a good and a bad thing.  The good is self-evident, the bad is the multitude of resources (time, committees, money, IT systems...) beig used across multiple MSO/PHOs all with a different flavour and angle.  I want to get those reports at a push of a button in real-time.  I have been using the Health Stat tool, and it's getting close.  Haven't seen Dr Info.
Cheers
Richard

One interesting question is whether the current structure of our healthsystem, which is reflected in current GP and hospital systems, is actually sustainable. Currently healthcare in most Western countries is very much centred around the practitioners and health-providers (governments, DHB, insurance company etc.). This makes sense considering the current funding formulas.
Considering the demographic and economic changes over the next 30 years I doubt that this is sustainable. Germany, which is regraded as one of them more helathy countries in Europe,  has 1.8 trillion depth and more than 4 trillion Euro future pension and healtcare obligations. I can't see any way to pay for this so the most likely solution is that entitlements (incl. health) will be cut as inconspicuous as possible.
This might work for a while, but eventually we will need a fundamatal change from the government companies talking care of your health to individual responsibilities. If this happens the emphasis will change to prevention and treatments fititng individual circumstances (incl. affordability). This change can be seen already with dental care where most Germans now have to pay 50% of their dental care (before it was entirely state funded) and as a result may choose cheaper (or no) treatments or travel to Hungry and the Czech repuplic where the same quality of care is half the price.By the way, I also know of New Zealanders who travel already now to Hongkong or Korea for dental treatment.
We might very well see the similar changes happen for other healthcare interventions. If yes, are the current GP and hospital systems still appropriate? In my opinion we need a much more patient centric system where the patients can take more control of their health, can make better use of the international healthcare market, and where much more emphasis is put on prevention and healthy lifestyle. I would like to see PHRs, EHRs and GP and hospital systems support such an approach.

Hi As part of the eastern bay6 EOI we  are loking into the shared patient record system to support an intergrated family health network.
 We are luckly that the bulk of practices run MT32 . There appear to be few Clinnical audit tools available. Dr Info seems to be a reasonably powerful tool and they seem to be doing some workl on having a PHO view as well as a local practice view available. Medtech are ceveloping a Tool that interfaces directly with the practice database which is a useful advantage and have a licence agreement with healthstat to alow PHO and national views and comparisons. . Still in beta at present but having some fun playing with it.Probably some way to go to catch up with what I believe DrInfo can currently offer.
We are hoping we can move to a situation utilising MT32, a managemyhealth type portal in a association with some social engineering tools ,under developement in the sector I believe ,to provide a network approach to the District health needs with a simple provider interface
Grahame