Since 1998, data about general practice activity in Australia has been collected, analysed and disseminated through the Bettering the Evaluation and Care of Health (BEACH) program. BEACH has provided valuable information about how general practice has changed over time, the impact of policy on practice and general practitioner (GP) professional development, and is the most reliable national source of data on GP activity. However, its cross-sectional design precludes comparison of outcomes of different approaches to care.
It is estimated that 96% of GPs currently use computers for clinical purposes. However, some GPs only use Electronic Health Records (EHR) for part of their clinical work, such as prescribing or ordering pathology tests. Others are paperless and only use EHRs, but even in these circumstances the EHRs themselves lack the structure to reliably link management actions to a patient problem. There are at least eight EHRs used in general practice, each developed independently and structured differently.
In short, there are no nationally agreed and implemented standards for EHRs in Australia, in three areas:
- EHR structure (including linkages)
- data element names and definitions
- use of clinical terminology and classifications.
Therefore it is not possible to reliably export standardised data from general practice EHRs of a sufficient quality to be used for clinical and research purposes.
With current policy focuses on data linkage, integration of care, improved use of the My Health Record (formerly the PCEHR) and attempts to use EHR data for research, the need for a reliable source of data from general practice EHRs has never been higher. Unfortunately there is no ‘quick fix’ solution, but the issues can be addressed with a targeted work program to address the three underlying problem areas.
This Issues Brief describes four steps required to produce high quality data from general practice EHRs:
- A defined EHR data model that links related data elements
- Consistent data element labels and definitions across EHRs
- Use of standardised clinical terminology and classifications
- Accreditation of GP electronic health records.
This recommended program of work requires a national, cohesive approach, involving stakeholders from government, professional organisations, the EHR software industry and organisations that use data from general practice.