The DIY super clinic

For a preview of the way electronic systems will operate in the consulting room of the future, you could start with the one shaped by the experience and sheer persistence of Melbourne GP, Henry Konopnicki.

The first thing you may notice about this system is that it doesn’t actually require the practitioner to be comfortably accommodated in a consulting room. Instead it reflects the likelihood that the consult of the future – like those of Dr Konopnicki’s present – will be a much more peripatetic activity, quite independent of such mandates as one-stop super clinics.

At the heart of the system is Melbourne-based KeyTrust’s Secure Health Net browser-based remote access and secure messaging service, which allows large-scale collaboration by practitioners without investments in high-cost, purpose-built software.

KeyTrust hosts Konopnicki’s clinical software, Medical Director 3 and Practice 2000 management software on one of its servers. That allows applications that were designed for a single user/single computer/single application environment to be used collaboratively.

Charles Greatrex, CEO of KeyTrust, describes it as “a federation of information”, secure and immediately available to each member of the team.

“It means that notes and documents from mental health professionals, pharmacists and other allied health professionals can be added securely in real time to core records controlled by a GP.“

Rather than replacing his existing systems with expensive purpose-built software that incorporates the needs of other professionals – which Greatrex describes as “a fairly big ask” which he believes is beyond practical reach because of the specialised requirements of each discipline – Konopnicki has moved what he works with into a cloud-computing environment. (He is currently negotiating to have the ability for files to be permission-based but is having trouble engaging the major medical software provider.)

Effectively he’s created a multi-room environment – a virtual multi-specialist practice.

Konopnicki’s system – he’s still thinking about what to call it – represents four or five years of painstaking visions and revisions, ironing out the limitations and problems he’s encountered with desktop and tablet PCs, wireless and cellular networks, secure messaging systems, scanners and virtual fax services, Medicare’s PKI authentication system, and more recently, the iPhone.

Before he began assembling it, he used the skills he’d gathered doing an MBA degree to build a business case on the project.

“I reassessed my approach, and decided that what I was doing had to be customer-focused. I thought about how I could improve my standard of care.

“Because my practice is in the aged-care area, I do a lot of my work off-site in hostels and boarding houses. I decided it wasn’t good enough to go out and not have access to all the information I needed. I wanted to increase productivity and be able to do everything at the point of contact. Now the initial consult takes me half the time, and when I leave, everything is in my database.”

The exercise forced him to examine every detail of his practice, and the way he worked with other practitioners. “The government talks about this sort of thing on a large scale. I wanted to do it just as effectively on a smaller scale.

“I was looking at chronic disease management, where a group of practitioners are working together, looking after a patient. In my particular case there is another GP involved, and we have a mental health nurse, outreach worker, pharmacist, psychologist, and a wound consultant at the Alfred Clinic collaborating with us.”

Konopnicki learned from one of his original experiments in adopting IT to his practice – a $5000 investment in scanning software and hardware – that each task had to be examined minutely. “You have to go to the people who do the work, and look at the workflow. You have to specify what information you need, where it comes from and how it comes in. You need to specify what fields you need to search on, and what key search terms you are going to use.”

You also have to be prepared to trash your investments when problems arise or the IT specialists, who will become particularly familiar to you as the project develops, point out unforeseen issues.

In the case of the scanning system, the KeyTrust IT experts who provide the 24-hour support critical to any EMR deployment enabled him to bypass the complexities of scanning that often require higher resolution and in some cases colour scans, creating huge files that threatened to cause serious back-up problems.

In his new system, Konopnicki has swapped his $5000 investment for a virtual fax service provided by Perth-based mBox Australia, which had come to his attention via an IT colleague he approached in his quest for virtual access. Now that is also about to be superseded by technology that addresses NEHTA security requirements.

But that is another story. We’ll explore that and other elements of the system and similar ones that are being developed in other areas, in future posts.