Patrick Bolton
It is generally acknowledged that general practice information systems will be useful and successful only if general practitioners are involved in their development. One way to involve GPs is to ask the their opinions. This paper explores what GPs say they want from a practice information system.
A group of approximately one hundred GP participants at the RACGP 7th Computing Conference were asked to list what they wanted from a general practice computing system. The respondents were a self selected group attending a conference instruction course 'How to go about that big first step - your first practice computer system'. It was divided evenly between people who had never used a general practice computing system and people who were dissatisfied with their present system and were seeking advice about a new one. Overall 80% of participants indicated that they had some past exposure to computers.
The items on participants' 'wish list' may be divided into structural and functional desires. Function refers to the system's ability to perform particular tasks while structure refers to how these tasks are done. Greater emphasis was placed on structure than function. This is logical since if a system is not easy to use it does not matter what functions it performs: it will not be used. This point was emphasised by the sub-group of participants who were dissatisfied with their present system.
The most important point to be made was structural: GPs want a system which will improve their efficiency. They want a system which will 'save us time'; 'improve practice efficiency'; and mean 'more money and less work'.
GPs recognise the value of a good system interface. There are a number of areas where improvement is sought. On the input side there was a desire for voice recognition; automatic data entry from external devices and service providers; and simplicity ('minimise clicking'). Graphical User Interfaces were seen to be important. The main criterion for output was a fast response time, especially in multi-user systems. Physically they wanted systems to be portable and to be designed so that they do not interfere with the doctor-patient relationship. A related concern was that the system should be 'simple to operate'; 'easy to learn'; 'foolproof'; and 'user loving'!
The final structural area relevant to individual systems that GPs believed important is reliability.
The respondents also saw the need for a number of structural changes relevant to healthcare informatics as a whole. These were:
Practice management is the best developed of these areas in Australia. Respondents asked less of this area than the other functional domains and much of what they asked for is already available. Requests included 'account rendered'; 'debt recovery'; 'prompt for change of address'; 'time management'; 'practice organisation'; and 'the ability to respond to Medicare returns/voucher problems'.
Probably the most interest in the patient management area was in the area of pharmaceuticals and prescribing. A drug database was regarded as important. This could provide prompts about possible interactions with other pre-existing patient medications and conditions and pictures of pills for easy identification. Prescription generation was also thought to be essential.
Other patient management information systems requested included: 'medical history summary'; 'instant medical reference'; 'patient recall generation (with labels)'; 'prompting (or check lists) during consultation' for screening and treatment; patient education media including 'graphics of body parts'; telemetry from external devices such as blood pressure and ECG machines; and 'interfaces with path labs'.
Functions important for continuing medical education are: 'education updates'; 'electronic communications between GPs'; 'audit and planning'; 'patient population and disease profiles'; and research.
The feedback provided by these GPs provides valuable information about their needs both to the medical computing industry and to those working to advance general practice information technology more generally.
GPs require systems which are efficient, easy to use and do what they do well. Research is needed to evaluate general practice systems on these terms and also to demonstrate the cost-effectiveness (or otherwise) of these systems. I believe that the lack of emphasis that the participants placed on practice management systems reflects their acceptance of the usefulness and efficiency of this type of product.
The range of needs expressed by general practitioners indicate that some structural changes are required in the healthcare system in order to reap the benefits of computerisation. These changes will need to be carefully considered and nurtured by the health informatics and general practice communities.
I would like to thank the participants in my conference instruction course 'How to go about that big first step - your first practice computer system' for their assistance in providing source material for this paper.
Patrick Bolton is a Computer Fellow of the Royal Australian College of General Practitioners, Rozelle, NSW.
