GERARD FLAHERTY <[log in to unmask]> writes
>Could I suggest that you reply say on a weekly basis to the following headings.

Heaven forbid!  GP-UK is an excellent medium for sharing and debating
ideas, but they need to be contemporaneous and fairly spontaneous!
>
>1.     "Why do you think computers are useful"
>for anything except fully automated industrial type jobs or at a pinch as a
>replacement
>for typing pools ?
>There is abundant evidence that they are expensive options for most medical
>clerical tasks
> especial if their if their failure rate was costed.

This is a sweeping generalisation.  What "evidence" do you mean?
Computers have taken off in General Practice as they can assist with a
moderately wide range of activities...

Repeat prescribing - the original raison d'etre, and still producing
safe, accurate, legible (unless stingy with the ink cartridge!)
prescriptions quickly and easily.

Acute prescribing in the consultation - ditto, plus warning of allergies
and interactions.

Disease index - recording those with important chronic diesases, and
allow planned care, that monitors the process and fact of their care (eg
Peak flows in asthmatics, TFT levels in those on thyroxine, etc)

Electronic medical record - this is perhaps the least advanced, but
those of us using a computer in every consultation (in my case for over
8 years now) find that it is easy to find similar past episodes, trace
the problem development, review previous prescription use, etc.

Health promotion - those who HAVEN'T had things like cervical smears or
childhood immunisations, or haven't been asked if they smoke... etc.

GP payments - last on list, but as part of the recording of patient
care, we can ensure that we get all the payments due to the practice
from the rather strange payment system that is UK general practice.

>
>2.     "Data collection is rarely of use"
>past the end of the current episode of illness.
>Retrospective research on data collected for other purposes is of little use
>for research.
>Though there are financial advantages in some countries but if use is un-planned
>it is a time consuming task to collectors.

I disagree!  The purpose of my computer record is not for research, but
to help with items outlined in 1. above.  We do also use the information
to target activity and to inform the Health Authority on purchasing
decisions.

>
>3.     "Present classification systems"
>are too big, have no clear function and there is no co-ordination of
>search engines between their designers and the collectors.

There are many different classifications, each designed for a specific
purpose.  The Read Code look up mechanisms do vary, and indeed our
system has just changed (mostly for the better!) to allow multiple
string searches.
>
>By the way I have been using Read Codes for two years, with a simple search
>engine. I and my
>partners have laboriously found/used about 3 500 individual terms in that
>time, about 15 000 times
>on 11 000 patients. The Read words are often inappropriate, diffuse and the
>search chaotic.
>The search routine was imposed on the designers of the search engine so that
>doctors could not
>have their choice as first choice but would be forced to key through
>alternatives........

The quality of implementation does matter.  Part of CAMS's role is to
advice on how to implement to allow GPs to use it best.

We have entered 700,000 Read codes, on a changing population of 6,500
patients over 8 years.  All partners enter at least one code per
consultation (together with a fair amount of free text!)

--
Jon Rogers                                 Tel: 44 117 950 7100
Southmead Health Centre                    Fax: 44 117 944 5498
Bristol BS10 6DF   UK                   e-mail: [log in to unmask]


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