Feeling the heat at
Burning GP
 
 

June 17, 2024

Feeling the heat at Burning GP

MediRecords joined the sun-starved throng flocking to the Tweed for the Wild Health Burning GP conference last week.

Here are 10 takeaways from two days of robust and enlightening conversations.

1. GPs are divided on the impact of Urgent Care Centres (UCC)

Are nascent UCCs an attempt to woo voters in outer suburban marginal seats, a means to divert a few people from crowded hospital emergency departments… or an example of government spending that would be better invested in primary care? The Royal Australian College of General Practitioners (RACGP) past president Adj Prof Karen Price also pondered whether UCCs are turning away “non-urgent” patients and referring them back to their family GPs.

2. There’s a great divide between GPs and hospitals

Healthdirect Australia is trialling a way to send NSW hospital discharge summaries to GPs and patients and Queensland discharge summaries are uploaded to The Viewer … but the data disconnect between primary and tertiary care remains vast*.

Associate Professor Alam Yoosuff, the Rural Doctors Association NSW vice president, said GPs were often left in the dark about hospital outcomes for their patients.

“We don’t always know if person has died, been discharged, or been sent home with only six (tablets)… We know the system is not right. It may be better than other countries, but we know it should be even better, given what (governments) are spending.” 

– Associate Professor Alam Yoosuff, the Rural Doctors Association NSW vice president

Judging by the overall vibe at Burning GP, GPs feel much of the government cash spent on shiny new hospitals could be better spent on disease prevention led by community-based primary care practitioners.

3. Workforce scaling

The RACGP warned Australia has a “whole of health” workforce crisis, exacerbated by insufficient medical students coming through, so we’re going to have to import doctors, nurses and specialists from overseas. (The ever-resilient Health Department Assistant Secretary Medicare Benefits and Digital Health, Mr Daniel McCabe, said he preferred “critical juncture” to crisis, triggering a running joke for the entire conference.)

Grampians Health Chief Strategy & Regions Officer Dr Robert Grenfell said the shortage of GPs in western Victoria was so acute he was planning based on having none. He said: “If we have (GPs) I will use them” but it was now prudent to make alternative plans.

4. Medicare misery is multiplying

Several conference panels highlighted the challenges of determining the correct, optimally reimbursed Medicare item codes for complex consultations. Mr McCabe conceded all billable items are due for review, with an aspirational goal of improving access to healthcare for people who can least afford it.

5. Telehealth – supplementary or threat?

If young and tech-savvy consumers keep opting for online access to quick prescriptions, medical certificates and more, community GPs will be left with older, sicker, more complex clients, including those with mental ill health. Whitebridge Medical Centre owner Dr Max Mollenkopf said GPs needed to understand why consumers are switching to digital health companies such as Eucalyptus and adapt fast. He said, “Our old patients who love us will die off and all the young ones will be (Eucalyptus patients) unless we do something different.”

6. The numbers speak for themselves

The Australian National University Associate Professor (and GP) Louise Stone highlighted a 42% pay gap between men and women GPs. She said this was compounded by women GPs shouldering a majority of longer, underfunded consultations with complex patients, (who may have been released from hospital prematurely to reduce bed blockages).

7. But metrics may deceive

Associate Professor Stone cautioned that ‘evidence-based solutions’ in healthcare may not be what they seem. Analysis had shown the typical participant in clinical trials is a privileged white male, the researcher is likely to be a white urban male and even the average lab rat is a white furred male. This means clinical metrics may not be representative … and AI tools risk exaggerating biased data even further.

Evrima Technologies CEO and Founder Charlotte Bradshaw said that 80% of clinical trials are delayed in Australia because eligible people can’t be found and paired with researchers.

8. The My Health Record (MHR) will grow exponentially

Mr McCabe confirmed legislation is imminent to mandate sharing diagnostic imaging and pathology with the MHR. The government will also “push very hard” for every medication event – prescribing and dispensing – to be uploaded. The CSIRO-led Sparked community will need to lead the software industry to a FHIR (Fast Healthcare Interoperability Resources) standard to achieve this. Mr McCabe said Australian healthcare was hamstrung by “a lot of technology built in the 1990s that is not fit for purpose”. The recent MediSecure data breach showed, “We need to make sure we set the bar a lot higher than it is today”.

9. Technology knowledge is variable

When you’re a time poor GP, technology is rarely top of mind. You just want it to work. GPs still need reassurance from healthcare influencers that cloud technology is as safe (or safer) than server-driven desktop tech and that switching brings cost and time savings on hardware, hosting, back-ups, security, software patches, electricity and more. As one GP said to us, “You mean I can sack my IT guy?”

As for innovations such as Artificial Intelligence (AI), there’s a sense that while there are time, safety, revenue and efficiency gains to be made, the early adopters and innovators will be waiting a while for their conservative colleagues to join them.

10. Summing up

Based on our conversations and observations at Burning GP, community general practitioners feel underfunded, overworked, undervalued, and under siege from telehealth providers and pharmacists. They’re a resilient mob though, and still passionately defending their role as number one for longitudinal patient care.

*MediRecords new Admissions module means we can provide a longitudinal record connecting primary and tertiary care in one secure, cloud-hosted software system. We can send Discharge Summaries from our Admissions module and store them against the central patient file. Please reach out to us at sales@medirecords.com if you’re trying to solve these types of connectivity problems!

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What are the keys to embedding telehealth into your practice?

October 6, 2023

What are the keys to embedding telehealth into your practice?

A new US study has identified reasons that some primary-care practices were better able than others to adapt to the surge in the demand for telemedicine during the pandemic.

We wanted to know if the Australian experience was the same, so we asked our telehealth partner, Coviu.

The study of 87 US practices, in the Annals of Family Medicine, found key factors were:

  • Prior experience with virtual health, such as knowing the importance of grouping telehealth visits together; and
  • Triaging rules, that is, clearly or not clearly knowing which patients could be treated virtually and which required an in-person visit 

Coviu observed during the pandemic that primary-care practices, boosted by the rapid introduction of universal Medicare reimbursements for phone and video telehealth, were quick to adopt phone for telehealth, but were more reluctant to adopt video telehealth, according to CEO Silvia Pfeiffer.

“This has remained the major approach to telehealth in primary care,“ Dr Pfeiffer said.

“This trend persists despite the government’s push for the adoption of video and compelling evidence suggesting that, for many visits, video results in better outcomes than phone calls.

“But for many primary-care services, phone telehealth is completely adequate, and for many patients without connectivity, phone is the only telehealth option.”

Coviu confirmed that practitioners throughout the Australian healthcare system demonstrated greater adaptability to telehealth when it was already integrated into their practice model, such as in rural settings, or when it was part of their pre-pandemic strategy.

“The absence of clear and consistent triage guidelines, especially early in the pandemic, contributed to the challenges faced by healthcare providers,” Dr Pfeiffer said.

“Triage guidelines help determine which patients should receive in-person care, telehealth consultations, or home care, and their absence can lead to uncertainty and increased workload for clinicians.”

She said when initially adopting telehealth during the pandemic, primary-care practitioners faced significant challenges including “unmet basic requirements, such as the absence of webcams or sufficiently powerful computers for telehealth”.

“In addition, many GPs lacked adequate training on what could be accomplished through video telehealth.”

Today, obstacles to wider adoption of telehealth include, “the stigma associated with video consultations, particularly among practitioners accustomed to in-person care”, Dr Pfeiffer said.

“Slow change management within healthcare organisations hinders progress, with a perception that video visits are inferior to in-person appointments, which does not apply in all instances. For example, mental health advice often leads to better outcomes when delivered via video in the comfort of a person’s own home.

“Reimbursements are still a challenge as the rules continue to change, causing confusion.

“Misinformation about privacy and security concerns as well as regulatory requirements also loom, impacting patient trust.

“Furthermore, inadequate training, both in technical software use and determining the clinical appropriateness of remote consultations, remains a hurdle.”

Factors Coviu says lead to successful telehealth adoption include:

  1. Digital knowledge within practices that already had digital communication mechanisms set up with their clients.
  2. Practices that strategically integrated telehealth into their workflows and adopted technology to make this seamless
  3. Practices that prepared their staff with training on their virtual-care workflow
  4.  Adoption of triaging rules by clinicians, as proposed by industry experts such as the RACGP, and other industry bodies and federations.

MediRecords has partnered with Coviu to streamline booking of video consultations with practice clients. Once your Coviu account is connected to MediRecords, any consultation nominated as a telehealth appointment auto-generates a link to the Coviu virtual consultation and your client is sent an invitation via SMS or email.

MediRecords and Coviu are both Australian developed cloud-hosted health technology companies.

Read more about Coviu on their website. 

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    A Missed Opportunity
     
     

    May 5, 2023

    A Missed Opportunity


    Matthew Galetto - Founder and CEO

    How the Australian Government Failed to Maximise the Potential of the GP Grants Program for Digital Health Adoption

    The Australian Government recently launched the Strengthening Medicare – General Practice (GP) Grants Program, allocating $220 million over two years to support general practices and eligible Aboriginal Community Controlled Health Organisations (ACCHOs). The program aims to provide funding for improvements in patient access, support safe and accessible quality primary care, and enhance digital health capabilities.

    As an observer of the digital health landscape both as a consumer (patient) and participant as a software vendor, I was eagerly awaiting the unveiling of the GP Grants program. I was hopeful that the grants would finally start to address the pressing issues of our time – a need to modernise digital health infrastructure, both private and public, focusing on standards and real-time information exchange at point of care. These are not just my observations; just about everyone working in the industry understands these problems, including the government itself within health departments and at the Australian Digital Health Agency (ADHA). And, of course, patients get it too. We all experience gross inefficiencies when we visit a doctor.

    Recently I learned from a colleague working at a primary health network (PHN), that no further details regarding the eligibility of the grant funding have been provided. The government has seemingly failed to establish eligibility criteria that effectively address the challenges faced by our healthcare system and specifically primary care and GP’s.  I don’t even think security of patient information is a requirement!

    Could have, should have – if only I had lobbied harder!

    Fast-tracking the benefits of a more connected healthcare system is crucial for improving patient care, reducing medical errors, and making healthcare more efficient. The adoption of Fast Healthcare Interoperability Resources (FHIR) and other interoperability standards can enable seamless communication between different electronic health record systems, thus facilitating information exchange and collaboration among healthcare providers.

    Unfortunately, the current GP Grants Program does not set specific eligibility criteria that focus on the adoption of cloud, security, FHIR or other interoperability standards – not even clinical coding standards! As a result, the program risks missing a critical opportunity to substantially enhance digital health capabilities across GP practices.

    The government’s lack of focus on cloud services, security, FHIR and interoperability adoption is concerning, considering the many issues GP practices face due to siloed databases and technology platforms designed a couple of decades ago. The current state of healthcare data systems not only hinders efficient patient care but also creates additional administrative burdens on healthcare providers. By not setting clear eligibility criteria targeting these issues, the GP Grants Program will not bring about much-needed improvements in digital health and interoperability.

    Unfortunately, there is a history in the Australian healthcare industry for key stakeholders and decision makers to listen to the voice of the ‘market share’, rather than the innovators, start-ups and disruptors looking to make a difference. It’s a chicken and egg scenario, no market share equals no influence, no influence equals no change. If only I had lobbied harder for change!

    What could have been, should have been. Recommendations for Improvement

    To maximise the potential of the GP Grants Program, the Australian Government should have considered the following recommendations:

    1. Set clear eligibility criteria that prioritise funding for GP practices adopting cloud, security, FHIR and other interoperability standards to ensure a more connected healthcare system.
    2. Encourage collaboration between GP practices and technology vendors to develop innovative solutions that address the challenges of siloed databases and improve data sharing.
    3. Establish clear guidelines on how the grants can be used for enhancing digital health capabilities, including specific recommendations for addressing interoperability and data sharing challenges.
    4. Look to other jurisdictions like the US, which have successfully modernised their digital health ecosystem. The US implemented the 21st Century Cures Act in 2016 which was well funded, mandated standards, promoted innovation, stimulated research and development and encouraged the use and uptake of web-based API’s. This had the effect of uplifting an entire ecosystem and encouraging a raft of new digital health entrants.

    An Unintended Consequence: How the GP Grants Programme May Impede Digital Healthcare Reform

    While the additional funding provided by the GP Grants Programme is undoubtedly beneficial for practices, there is a valid concern that it may have unintended consequences.

    If practices invest grant money in outdated technologies, they essentially lock themselves into using these systems for the next 3-5 years, as assets typically depreciate over this period.

    This potential outcome of the GP Grants Program could have a perverse impact on the government’s ability to implement much-needed digital healthcare reforms. By inadvertently supporting continued use of outdated technology, the Program may slow the adoption of innovative solutions such as cloud, security, API’s, FHIR and interoperability standards. In turn, this could delay the realisation of a truly connected and efficient healthcare system, which is an urgent priority.

    It is disheartening to acknowledge that Australia is already lagging behind many other countries in terms of modern cloud-based digital health solutions. This funding, if not appropriately directed, will only serve to widen the gap between Australia and other nations leading the charge in healthcare innovation. The prospect of falling further behind should be a wake-up call for the government to re-evaluate the GP Grants Program and ensure it truly supports the advancement of digital health capabilities across the country.

    It is never too late!!

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