Forty years staring at the screen

I am a geek. Homozygous recessive. My father was a geek and my mother was not, but she must have had one gene in there.

IT and general practice have come a long way since the 1980s, when my father bought a second-hand 20-mega­byte hard drive for Mornington Health Centre in Dunedin. He got it second-hand because he could make a huge saving. (He paid $5000.)

What makes a geek? The fundamental thing, I think, is that when trying to fix a problem, instead of frustration, anger, swearing and confusion, geeks have a calm determination to get it sorted. While most people experience rising cortisol, geeks get a rewarding rush of dopamine and serotonin when their solution finally succeeds. Like most things that reward you with serotonin and dopamine, it can be a bit addictive.

I have been pondering what my colleagues in general practice might like to learn from my monthly articles, what would make your lives easier and your businesses more efficient. The most useful thing you could do is ensure that at least one of your senior staff is homozygous-recessive for the G gene. Of course, early geneticist Gregor Mendel tells us only about one in four of your staff will have this quirk.

You are more likely to have one of us on your team if you work in a large practice; in a small practice, you would have to hit it lucky. If you don’t have a geek on hand, then I hope this column will be useful. Some of it will be fairly general, but I intend to give some specific advice as well.

To get the ball rolling, here’s my perspective on health IT in New Zealand over the past 40 or so years.

For a long time, New Zealand was seen internationally as the most advanced country in the health IT space. We have some pioneers to thank for that:

• Robin Churchman, at Medtech, who put together software for streamlining appointments and accounts at general practices
• Alan Chew and soon after Derek Gower, at Houston, who provided competition to Medtech, and
• Tom Bowden, of Healthlink, who enabled laboratory results to be sent to practices.

This set the scene in the 1980s for what was to come next. Computers let us organise and transmit information that makes our businesses more efficient.

The New Zealand health IT system continued to grow with other practice management system (PMS) providers

like MyPractice, from Ashwin Patel, and Orion, for hospital systems, from Ian McCrae. The growing ecosystem proved fertile ground for developers to add features for this software: companies like Vensa, which added its text-to-remind service; BPAC Inc, decision support; and a multitude of dashboards, referral systems and patient portals. In the past few years, another major PMS provider, Indici, has moved fully to a cloud-enabled system.

This growth was not always informed by standards but was often a small number of companies getting together, sometimes in a friendly way, sometimes in a more strained way, to link up the ecosystem.

Over time, this led to legacy debt, where the old ways of joining systems have become too complex and too varied, slowing New Zealand’s speed of innovation. Now, we are very much in the next phase.

Legacy systems are being converted to standards and the road ahead is starting to become a bit clearer. All these innovators wanted to help busy practices, like my father’s in Dunedin, run more efficiently and effectively.

People sometimes curse the screen in front of them, and I suppose it would be possible to run a practice with pen and paper, but it would be difficult and time-consuming.

Love them or loathe them, the computers are here to stay. The trick is to use them effectively. I’ll try to give a tip most months about how to use your software effectively.

My general practice uses Medtech Evolution, so most of my examples will come from there, but the principles will be the same no matter what software you’re using.

The tip I want to give this month may seem very basic, but many doctors and nurses don’t know about a basic feature of all software, and that feature is filtering.

Most tables and fields in your PMS will have an icon for filtering. Use it! In your medications list, right-click on a medication and filter your Daily Record to see the notes you wrote each time you prescribed it. Right-click for this medication only to see a list of dates when you have prescribed it.

Do a keyword search and the Daily Record for the word “prostate” or “DRE” (digital rectal examination) to see if you’ve done an examination.

Filter your Daily Record to see each time you’ve seen someone for a diagnosis of asthma.

The huge advantage the computer has over pen and paper is this ability to order and filter and rearrange data. Don’t treat your computer as pen and paper, it can do a lot more than that.

Sometimes my colleagues are like my friend John, a smart guy who in the 1990s at the University of Cambridge, UK, was doing a PhD in human nutri­tion. John would enter rows of numbers into Excel, then get out his calculator, add up those numbers and put the total in at the bottom! He was amazed when I showed him how the computer would do that for him. Don’t be John.