Is the medical software industry holding us back?

There’s a Dutch theory called ‘De wet van de remmende voorsprong’ which, according to Wikipedia, translates as ‘The law of the handicap of a head start’. The theory suggests that an initial head start by an individual, group or company often results in stagnation due to lack of competition or growth stimuli. This may eventually lead to losing pole position.

General practice was one of the first fully digitalised, more or less paperless, medical disciplines in Australia. The question is, are GP software packages keeping up with the times or is the profession at risk of falling behind and being overtaking by others?

Good job

Overall I am satisfied with the desktop software I use to look after my patients. It does the basics very well such as recording patient demographics and medical history, medication management, printing scripts and investigation referrals.

It also checks if medications agree with each other and if the patient happens to be allergic to a new pill I am about to prescribe.

But compared to, let’s say, ten years ago there haven’t been any breakthrough innovations. Sure, we can now check the national My Health Record and upload a shared health summary, but there’s also a lot to wish for.

GP Desktop Software
Are GP desktop software vendors holding general practice back?

We’re still relying on the good old fax machine and over the years I have seen more and more third-party software solutions appear on our system to perform tasks the desktop software can’t. Occasionally these packages clash with each other or slow the practice system down.

The wish list

Here’s a list of 7 basic things that should be included in all GP desktop software. I believe it would improve patient care and satisfaction.

  1. I’d love to have the option to communicate securely with patients and other providers, asynchronously or via video link.
  2. Our patients should be able to send digital health data or electronic script requests via a secure connection.
  3. An online appointments booking system.
  4. GPs should be able to send scripts electronically to the pharmacy.
  5. It would be really nice if the software would help us to write (and send) smart electronic referrals by automatically inserting the data required by the specialty or provider we are referring our patients to.
  6. Decision support tools offer benefits such as increased diagnostic accuracy and a reduction of unnecessary tests.
  7. We also need integrated data analysis and data cleansing tools to help improve the quality of general practice data, so it can be better used for in-practice quality improvement processes.

What’s on your wish list?

12 thoughts on “Is the medical software industry holding us back?

  • Currently point 4 is restricted by state legislation & federal regulation rather than technology.

    If the legislation changed, my understanding is that the electronic prescription repositories can implement this now.

    Although it would be indirect – GP to repository; nominated pharmacy accessed script when directed tondo so by the patient.

    Liked by 2 people

  • Excellent suggestions Totally agree General practice is already very efficient in regards to what is being delivered in Australia but we should always be striving to be better

    Liked by 1 person

  • Yes, excellent suggestions Edwin … fed up with having to fax instead of being able to send / receive correspondence electronically and securely. Point 5 .. wouldn’t that be great!
    However, reflecting a special interest area… but no apologies for that because much of what I do is “usual general practice” anyway, there should be better ways of recording asthma and COPD basic indicators of care eg an asthma control test score, CAT score (for COPD); whether and when a patient has attended pulm rehab ; exacerbation data, etc.
    In Best Practice the spirometry data collection field is woeful and almost useless (I really do need to contact them about that).

    Liked by 1 person

  • My 23 articles published by Medical Observer since November 2015 outline my wishes:

    Oliver Frank. Address books need to reflect the reality of current practice. Medical Observer. 3 Nov 2015. (This article proposed that the address books of GPs’ clinical software packages should recognise that most health professionals practise in groups.)

    Oliver Frank. Prompts would help GPs keep track of patient changes. Medical Observer. 28 Jan 2016. (This article proposed that GPs’ clinical software packages should prompt GPs and their staff at specified intervals to confirm or else update patients’ contact and demographic details.)

    Oliver Frank. How to improve the recording of patient refusals. Medical Observer. 24 Feb 2016. (This article proposed that GPs’ clinical software should have structured means of recording a patient’s refusal of or ineligibility for elements of preventive and other care.)

    Oliver Frank. How to improve the recording of requested appointments. Medical Observer. 23 Mar 2016. (This article proposed that GPs’ clinical software should record the appointment that was requested, as well as the one that was given.)

    Oliver Frank. Lack of focus on family history is a missed opportunity for GPs. Medical Observer. 2 May 2016. (This article proposed that GPs’ clinical software should have structured means of recording a patient’s family health history.)

    Oliver Frank. How to reduce risks from drug lists. Medical Observer. 22 Jun 2016. (This article proposed that GPs’ clinical software should generate a new list of the patient’s current medicines for the patient and the pharmacy whenever this list changes.)

    Oliver Frank. A suggestion to improve the tracking of stray medicines. Medical Observer. 19 Jul 2016. (This article proposed that GPs’ clinical software should prompt them to confirm the currency of medicines in the patient’s list of current medicines.)

    Oliver Frank. A little more detail could vastly improve health summaries. Medical Observer. 15 Aug 2016. (This article proposed that GPs’ clinical software should show more details in health summaries about the patient’s current medicines.)

    Oliver Frank It should be easier for GPs to work out the cheapest drug options. Medical Observer. 5 Oct 2016. (This article proposed that GPs’ clinical software should show how the patient could buy a newly advised or prescribed medicine most cheaply.)

    Oliver Frank. More could be done to flag renal issues when prescribing. Medical Observer. 23 Nov 2016. (This article proposed that GPs’ clinical software should prompt them to check and review the patient’s renal function when prescribing or re-prescribing medicines that influence this or whose effects are influenced by it.)

    Oliver Frank. A small change could bring efficiencies to pathology test requests. Medical Observer. 15 Dec 2016. (This article proposed that GPs’ clinical software should require and help them to include relevant clinical details on requests for investigations.)

    Oliver Frank. Wouldn’t it be great if GPs could see who else a patient was consulting? Medical Observer. 24 Feb 2017. (This article proposed that GPs’ clinical software should capture and display the details of the patient’s future appointments with other health professionals, organisations and services, so that the GP can remind the patient.)

    Oliver Frank. Patients should be able to add notes to their clinical record. Medical Observer. 20 Mar 2017. (This article proposed that GPs’ clinical software should allow patients to add their agenda for the consultation to the clinical record, before the consultation.)

    Oliver Frank. How we can fix poor quality data in GP software. Medical Observer. 18 April 2017. (This article proposed that GPs’ clinical software should monitor the quality of data as it is being entered, rather than retrospectively.)

    Oliver Frank. Practice software should better reflect the importance of preventive interventions. Medical Observer. 23 May 2017. (This article proposed that GPs’ clinical software should be able to generate a prevention summary to give to the patient).

    Oliver Frank. Our software needs to better track self-prescribed substances. Medical Observer. 6 June 2017. (This article proposed that GPs’ clinical software should enable structured recording of all substances used by patients.)

    Oliver Frank. We need to streamline reminders when a GP is absent. Medical Observer. 10 July 2017. (This article proposed that GPs’ clinical software should have a system to forward incoming tests results and correspondence of absent GPs to nominated colleagues in the practice.)

    Oliver Frank. Medical Observer. Why does crucial patient information reside in so many different places? 7 August 2017. (This article proposed that GPs’ clinical software should for each of the patient’s health problems display on one screen all of the information about that problem.)

    Oliver Frank. GPs need to see when a secure electronic letter has been delivered. Medical Observer. 4 September 2017. (This article proposed that GPs’ clinical software should display the delivery status of letters sent via secure messaging.)

    Oliver Frank. Individual patient billing history should be instantly accessible. Medical Observer. 8 November 2017. (This article proposed that GPs’ clinical software should display fees billed recently when they are seeing patients who usually see other GPs in the practice.)

    Oliver Frank. GP software should be more useful when lawyers come knocking. 11 December 2017. (This article proposed that when needed, GPs’ clinical software should assemble all of the information in the patients’ record in chronological order, and provide a redaction tool.)

    Liked by 1 person

  • You are correct. And, Oliver Frank is amazingly organised. I am full of envy. My wishes are light years behind yours. I would like emails and not faxes from hospitals and pathology providers. I would like the hospital ones to have a doctor’s name on them. I would also like emails from specialists and would regard it as a courtesy if they did not say: ” Dictated but not signed”. A recent one also said: ” if this letter contains any errors please notify my secretary”.

    Liked by 2 people

  • I would like signed letters and communication by email , not fax. Last one from a specialist: ” dictated but not signed. If there are any errors please notify my secretary and she will correct them”.

    Liked by 1 person

  • This is important work Edwin, and from other contributors here. It deserves to be far more widely read and spread 🙂

    I would add to this list:
    (i) standardise termsets so that any important/vital clinical data is clearly understood by everyone – including patients, referral sender/recipients, pharmacy, allied health colleagues, hospitals and is then entirely comparable for all analytic purposes (in your own clinic and your own patient data collection or population wide)
    (ii) outlaw ANY FREE TEXT in what would otherwise be ‘CODEABLE’ data fields – this functionality might seem attractive to users but has several scary effects:-
    (a) free text doesn’t trigger clinical decision support reliably – so risk is increased (especially drug-disease interaction rules)
    (b) coded data is more likely to qualify your patient cases for funded health programs (PIP) etc, so you’re not missing out on the $ you have earned
    (iii) free text clinical documentation (in CODEABLE fields) often reveals real patient names, phone numbers – all the aide-memoirs that Drs always need… but this risks privacy and confidentiality.

    (aside: free text narrative is fine, but is isn’t “real” data that should be exchanged/exposed)

    I’ll refer you also to the new RACGP Accreditation Guidelines Ed5, which deals with codeable data and privacy…. and lots of other helpful advice there as well.

    Lastly Oliver, could I encourage you publish all your articles in a single compendium that is freely available (to non-subscribers)?


    Liked by 2 people

  • Great article Edwin! Initially when the software companies were fighting for market share updates and enhancement were a regular affair. I remember wishing the rate would slow down because they often broke the software. One needs to be careful what one wishes for because now improvements and enhancements to the software have slowed to a trickle.
    Fabulous work Oliver as well.
    If my clinical software where was a mobile phone it would be a Nokia 3310…. really good but a bit dated because my expectations of my mobile phone have grown. As you suggest because it is so difficult to change software packages there is no imperative for the software companies to continue in a process of improvement.
    The software is basically really good, nevertheless it is time to make it fit for purpose in the 21st century.
    I think it is symptomatic of the problem that a myriad of third-party providers stepped in to fill the gap.

    Liked by 2 people

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