beyond pt 0 23/1

are introduced to market at a startling rate each year. This trend is itself
changing the use of delivery channels in health as reduced length of stay
in hospital is strongly associated with more effective pharmaceutical use.
The major issue posed by e-commerce in the service delivery channels is
the requirement to settle on a standard form of electronic record keeping
and to establish systems for storing and communicating information
which are appropriately authorised by patients and providers, which are
secure and reliable, and which are efficient in the face of the different
contexts and requirements of the vast range of episodes of care.
General practitioner services
The Australian healthcare system is built around the general practitioner
(GP). As gatekeeper of the system, access to specialist health providers
and much hospital and nursing home admission requires referral from a
general practitioner, who provides an initial assessment and makes or
assists in the choice of secondary health provider.
Computerisation of general practice accounting functions is commonplace
but the use of information storage, retrieval and communication to
support direct clinical practice has, until recently, been very limited. The
early applications on the GP desktop have been electronic script writing
applications. However, electronic messaging from the GP desktop has
been slow to develop and is still in trial mode as there is no widely
accepted encryption/authentication protocol in place to ensure
appropriate security and privacy of electronic messages. Several trials
of electronic messaging in ordering and reporting on diagnostic
tests, communications with other practitioners, discharge summaries
from hospital treatment episodes and continuing medical education
are underway.
The Australian Government’s General Practice Strategy Review made
recommendations designed to accelerate the use of appropriate
technology to support general practice. Government introduced a Practice
Incentive Payment to encourage computerisation and electronic
communication by GPs, which is having a marked effect on the
penetration of clinical computing and communications applications. In
addition, work is proceeding on a standard Australian electronic health
record for GP use.
Specialist medical services
Specialist medical consultation services are generally provided by
independent practitioners in solo or group practices, or by public hospital
outpatients’ clinics. Many public hospital outpatients’ clinics also have
links to university medical education programs.
The level of technology awareness and penetration of computing and
communications equipment is generally higher in specialist practice.
Electronic communication among practitioners is increasing, and many of
the research databases and specialist biomedical journals are now available
electronically. Professional collaboration for training and quality
improvement is generally organised by the specialist Colleges, which
increasingly are using electronic messaging and Internet technologies to
support their work. For example, the Royal Australasian College of
Surgeons has been holding an online virtual conference for several months,
and the Royal Australasian College of Physicians has extensive online
resources including their newsletter and a ‘jobs vacant’ service for members.
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