GPs are being asked to take up thy mouse and co-ordinate
Disconnected ... Only 27 per cent of Australian GPs report they can electronically exchange patient summaries and test results outside their practice. Photo: Andrew Quilty
In a recent speech at the National Primary Healthcare Conference, federal Health Minister Tanya Plibersek outlined her arguments for shifting the centre of gravity of Australia's healthcare system towards primary care and the key role of general practitioners and other clinicians who deliver these services. In doing so she acknowledged the growing evidence that primary care produces the best health outcomes, is cost effective, and offers real possibilities of tackling local community needs and resolving health disparities.
Healthcare reforms in several high-income countries are increasingly focused on designing and redesigning primary care to improve the health of the population and the quality of healthcare services, provide better access to services, and develop more integrated care systems. The goals are to keep everyone as healthy as possible through preventive services and early interventions, to supply the needs of an ageing population with a high burden of chronic conditions, and to keep costs under control. These goals will only be achieved if the reforms are underpinned by better teamwork and communication between primary care, specialists, hospitals and aged care. These underpinnings, and the necessary concomitant improvements in quality and safety, require the implementation and use of health information technology and feedback to clinicians on their performance.
A recently published survey by the New York-based Commonwealth Fund of primary-care doctors in 10 countries provides a front-line perspective and assessment of how current healthcare reforms are impacting patient access, health IT capacity, communication across sites of care, and feedback on practice performance. While Australia's overall performance in this survey puts us in the middle of the pack with respect to several European countries, Britain, the United States and New Zealand, the survey shows that there is still quite a way to go before claims about meaningful primary-healthcare reform in this country are validated.
A key aspect of the survey was to measure progress in the use of health IT. While nearly all Australian GPs report using electronic medical records, it is embarrassing and puzzling that Australia has apparently gone backwards in this regard since this survey was last conducted, in 2009. In 2012, 92 per cent of GPs report they are using electronic medical records, down from 95 per cent in 2009; and the reality is that, despite the enormous sums expended on e-health, interconnectivity where it matters most is minimal.
Only 27 per cent of GPs report they can electronically exchange patient summaries and test results with doctors outside their practice. Barely a quarter of Australian doctors said that their patients could use email to contact them about medical questions or concerns. When a patient is seen by a specialist, a GP gets all the relevant information, including information about changes in the patient's medication, only one-third of the time; and in just 13 per cent of cases is that information provided in a timely fashion or when needed. Less than 25 per cent of GPs are notified when one of their patients has been to the emergency department or discharged from hospital.
Moreover, Australian GPs get little performance feedback. They are more likely to know about patients' satisfaction with services than their clinical outcomes. Only 25 per cent of GPs routinely receive information that captures their practice's clinical performance compared with other practices.
The new Medicare Locals are being asked to take on the role of improving the co-ordination and integration of services to improve the patient journey and to provide support to clinicians to improve patient care. Although this represents substantive organisational reform, several other aspects of the Australian healthcare system that impose barriers to needed change remain.
For example, patients, even those with chronic conditions needing continual monitoring, are not required to register with their GP or a ''medical home'' and this, combined with the voluntary nature of co-ordination and communication between clinicians and services, leaves GPs uncertain of the extent of their responsibility for ongoing care co-ordination.
The National Primary Health Care Strategy, released in 2010, made it clear that Australia must harness the benefits of technology, including e-health, and provide the infrastructure, equipment, skills and organisational arrangements that GPs need to deliver 21st-century primary healthcare to all Australians.
This work is under way but, as the Commonwealth Fund report highlights, there is much more to be done to achieve the Health Minister's vision.
Dr Lesley Russell is a Senior Research Fellow at the Australian Primary Health Care Research Institute at the Australian National University.