Progress being made on ‘huge problem’ for GPs

Clinical information systems (CISs) are vital tools in the delivery of safe, high-quality general practice care, but their inability to communicate with each other is hampering the Austrlaian healthcare system, according to the RACGP.
 
A newly released college position statement has laid bare the ongoing issues plaguing GPs and other clinicians, highlighting issues related to interoperability, inconsistent integration of electronic clinical decision support, poor data portability, and the display of patient information.
 
This lack of functionality can impact everything from patient care, to health system efficiency, and even research and public policy. Dr Rob Hosking, Chair of RACGP – Practice and Technology Management Expert Committee, told newsGP it is a ‘huge problem’, with poor interoperability at its core.
 
‘Talk to any GP any day and patients expect that information has already been shared and it’s not,’ he said.
 
‘For example, patients are asked to go and follow up with their GP after they’ve attended an emergency department and had a whole bunch of tests, and the GP then spends half of the consultation trying to access the information – or they can’t access it at all.
 
‘Then you get patients who transfer between general practices because they’ve moved or they want to attend a different general practice for a different reason, and their information is not available either.
 
‘They have to verbally, or mentally carry it with them and try to present it to the GP, who then has to trust the validity or try to understand what the patient’s terminology is in medical terminology.
 
‘Transferring information around in a standardised fashion that can integrate with existing computer systems would help generate better health outcomes for patients and better efficiency for GPs.’
 
But while these scenarios remain all too common for many GPs, hope is on the horizon.
 
A collaboration involving the CSIRO, Austrlaian Digital Health Agency, not-for-profit e-health company HL7, and the Department of Health and Aged Care – informed by the RACGP and clinicians on the ground – is aiming to standardise communication between different CISs and remove the current inefficiencies afflicting the system.
 
Interoperability Lead at the CSIRO’s Australian e-Health Research Centre (AEHRC) Kate Ebrill told newsGP the program, Sparked, has already made great strides since being established in August 2023.
 
‘It’s really the first time where we’re looking at doing a truly collaborative, bottom-up community process to ensure that we can develop these foundational steps and make sure that they’re fit for purpose for clinicians,’ she said.
 
‘We want to ensure they add utility and benefit to clinicians, are consumer-focused and feasible to implement, and that the [Federal] Government is working with us in parallel to look at how they can enable it from a policy perspective.’
 
Establishing the Fast Healthcare Interoperability Resources (FHIR) standard, which provides a shared ‘language’ by which systems can communicate, is at the project’s core. And while it may be new to Australia, it has been successfully implemented in many other parts of the world, including the US.
 
‘Importantly for Australia, we get to leverage the benefit of that, because a large number of vendors are already mandated to implement that in the US,’ Ms Ebrill said.
 
‘We’ve been able to look at what the US has done, work with our clinicians, industry and government here and say, “what can be reused? But what also needs to be localised to support our regulatory environment, and clinical and consumer needs?”
 
‘The aim is to only vary where we need to vary.’
 
The prospect of a FHIR standard is one that excites Dr Hosking.
 
‘If all our systems use that communication standard, then you don’t need to, if you like, integrate with every different system that’s out there – we only need one language that communicates between all the different systems,’ he said.
 
‘Interestingly, there’s very positive support from the industry as well … [and] we’re starting to see FHIR-based systems already incorporated into our GP computer systems.
 
‘For example, the integration of the Australian Immunisation Register – the ability to view that immediately on our desktops, from within our GP software and import the information directly into our GP software, is a huge improvement on what we had before.’
 
And while Dr Hosking says the change is likely to emerge gradually, rather than in ‘one big bang’, Ms Ebrill is hopeful that GPs will start noticing the difference by June next year.
 
‘It does take time for design and agreement and build, to then get tested and validated on the market,’ she said.
 
‘But I hope from 2025 onwards, that we’re going to be in a position where we’re starting to see industry pick up the fundamentals and implement these standards.’
 
The Sparked project has already released its draft AU core dataset for interoperability, which went out for public comment two weeks ago, and Ms Ebrill would like to see more GPs involved in the development process, providing feedback.
 
‘The AU core dataset was developed through a clinical design group, where we’ve got a number of representatives from across general practice, across other health professionals, industry, government – everyone coming together to really say “this is what we think is that foundational data”,’ she said.
 
‘We’ll then we turn it into a core FHIR implementation guide … which supports … 80% of transactions between systems to support interoperability.
 
‘This isn’t about a meeting of five people. We have over 100 people engage in our sessions and we encourage anyone to get involved who wants to get involved, because the more people … the better the product we have at the end of the day.’
 
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Australian Digital Health Agency clinical information systems CSIRO digital health FHIR HL7 interoperability