General Practices and the Increasing Use of IT Infrastructure
While General Practices are medical setups, they still, more than ever, use IT infrastructure to meet operational and functional requirements. The increased computerization of medical care such as the electronic management of health-care records, data storage, and the need to collaborate and research issues such as drug interactions means IT is increasingly being used in medical practices. Many business processes are designed to create value; however, IT systems is one area where the concept of value realization is most strongly adopted, especially in the context of Enterprise Resource Planning (ERP) systems. IT value realization pertains to demonstrating the tangible benefits of a given IT system. In this paper, the concept of IT realization is evaluated in the premise of a general practice in Australia. This paper is a collection of data and information regarding the business aspects of a general practice. Information is collected on the business requirements of a doctor’s practice. This is then followed by information/ data on software package solutions that can be used in the general practice
Nature of the business context of a doctor’s practice
Australia has a robust and growing general practice sector of the medical services industry, driven largely by increased demand from the country’s aging population: this growth has especially been evident in the past five years (‘IBIS World,’ 2018). This is because General Practitioners (GP’s) are the first contact point in the Australian medical system where patients get direct treatment through diagnosis of their health problems and referral of patients to other general hospitals or specialists. The government provides GP’s with funding under Medicare to cover scheduled fees for every consultation. The revenues for the general practice sector in Australia is $ 12 billion, and is experiencing an annual growth of 2.8% per annum. The sector employs 69681 people, and the size is 43999 businesses. The products offered by the sector include general treatments (including unspecified treatments), treatments for respiratory and circulatory problems, skin treatments, musculoskeletal treatments, psychological treatments, metabolic, endocrine,and digestive treatments, as well as other treatments. The sector faces various challenges, including the capacity to fulfill its very important role in providing primary care, challenges due to finances, capacity to offer comprehensive care, administrative challenges, and seamless integration with the rest of the health care system (Harris & Harris, 2016). Further, general practitioners must also engage in usual business practices such as administration, marketing and advertising, finance management, human resource management and staffing, as well as deal with legal issues and challenges (Habib, 2016).
Overview of the General Practice Sector in Australia
Areas of breakdown in General Practitioners Practice
General Practices in Australia still have to operate under the constraints of limited financing, limited personnel, and limited capacity of operation; for instance, they can only offer help for certain general conditions. The general practitioners are also paid less, by almost a third of what specialists get paid, and so in real terms, the number of general practices and practitioners are decreasing as more people choose to become specialists (May, 2017). The morale of general Practitioners is on the downward trend due to a freeze on their fees. The general practices must first register with the Australia medical Board and then obtain Government licenses as well as local licenses to operate as a business. Beyond these legal requirements, practices must also invest in insurance and clear operational policies, source for a practice manager that is reliable to cover business, management, human resources, finance, and marketing requirements. Practitioners must also use technology to remain relevant in the modern era of health-care, and to be linked with other health systems (Habib, 2016).
Services Performed by General Practitioners
General practices receive patients, have them diagnosed, and treated or referred: however, there are more details to be handled, including taking patient records and managing them safely, reviewing past history from other health systems, billing, insurance processing, handling payments, procuring equipment and supplies, ensuring safety, and working with other staff people. Further, general practices must prescribe and administer drugs and have these records safely stored and updated, in addition to making claims to medicare, filing statutory returns, and paying business expenses including telephone, internet, rent, and any local fees (Saunders & Tierney, 2011).
Vendor Offering EHR Solutions
The vendor to be evaluated is among the top EHR vendors in Australia; the top vendor is chosen because they are likely supplying products and services to several health care institutions and therefore understand the market and products better in order to be the top provider. The vendor supplying EHR system is Epic Systems (found at https://www.epic.com/).
Background of Vendor (EPIC)
The company is among the top EHR vendors in Australia (currently occupying position two in terms of ranking) according to CureMD (2017). Epic Systems is a health software products provider, founded by Judith Faulkner in 1979 in Wisconsin, USA and is among the oldest health-care software vendors. It has grown and now has a global presence, including in Australia. To get a perspective on its size, 190 million patients have their health records currently handled by Epic (‘Epic,’ 2018). Health software made by the company is used in community hospitals, retail clinics, children organizations, independent/ general practices, skilled nursing, integrated delivery networks, safety net providers, academic medical centers, hospices, rehab centers, and multi specialty groups. Epic caters to medium and large sized health care centers and its software is developed in-house: it is owned mostly by the employee and led by software developers. In the KLAS rankings, it has been ranked number 1 for the past five years (‘Epic,’ 2018).
Challenges Faced by General Practices in Australia
Functions Offered by the Software
The software is developed with the patient at the center of it; it comes with features that include patient engagement, clinical s and clinical management, specialties, mobile applications, care at a distance, managed care, population health, revenue cycle management, and is inter operable with other health care systems. Further, the software is developed with a keenness to ensure compliance with government regulations. The firm does not just develop the software; it has an implementation team tasked with the job of implementing the system, working with the client, such as a GP or a clinic/ hospital. The implementation enables customization of the software to meet specific client needs. The company also offers training including certification courses on the use of the software. The firm also provides technical services to clients through a dedicated 24 hour help service, in addition to monitoring the system, and undertaking regular checkups to ensure success. The vendor also provides ongoing services and continuous improvement services.
Architecture
The EPIC EHR uses a High Avalability Reference Architecture based on proven backup, business continuity, continuous availability, and centralized reporting. It has a cache and backup database that are replicated by cloning as depicted in the diagram below;
Source: EPIC EHR
Equipment Requirements
Installing the system requires a computer with server capabilities, with at least a Dual Core/ Core 2 Duo processor with minimum speeds of 1.6 GHz. The system requires memory of at least 4 GB, with at least 20 GB hard disk storage.
Risks in Implementing the Software
Implementing the system comes with risks, including during installation and its use. Planning failures can occur, with research showing half of all complex EHR installations fail, especially when it involves migrating from one system to another (O’Connor, 2015). Another challenge is delay in implementation and a huge financial exposure with delays in returns on investments. Another major risk is the breach of the data stored within the system, such as by hackers or accidental exposure that can lead to serious legal repercussions for the general practice. Another risk is that of human error or inability to operate the software properly or as required, resulting in the software slowing down operations or causing errors (Raposo, 2015).
Software Cost
The software costs about $ 10272 per physician per year, or about $ 856 per physician per month, based on analysis by one f its users.
Implementation Roles and Responsibilities
The implementation will have a project manager who will be the product owner, and a cum master to ensure the project objectives are met. A technical person will oversee testing and customization, working with a team from EPIC; the implementation will follow the Agile SCRUM methodology of several iterations being stalled, configured, and tested and amendments made until the right customization is achieved. The common practice is to install the software on a server and then use it over the network in client computers, such as those used by the practice manager. It has capability for cloud implementation where users access the service over the internet in the cloud for storage and daily applications. Further, it has a mobile component and can be accessed remotely using mobile devices.
References
‘CureMD’. (2018). EHR Software Companies Comparison – CureMD. Curemd.com. Retrieved 20 April 2018, from https://www.curemd.com/top-ehr-vendors/
‘Epic’. (2018). About Us. Epic.com. Retrieved 20 April 2018, from https://www.epic.com/about
Habib, R. (2016). 8 Considerations For Opening A Medical Practice In 2017. Clinictocloud.com. Retrieved 20 April 2018, from https://www.clinictocloud.com/blog/8-considerations-for-opening-a-medical-practice- in-2017
Harris, M., & Harris, E. (2016). Facing the challenges: general practice in 2020. Mja.com.au. Retrieved 20 April 2018, from https://www.mja.com.au/journal/2006/185/2/facing-challenges-general-practice-2020
‘IBIS World’. (2018). General Practice Medical Services – Australia Industry Report | IBISWorld. Ibisworld.com.au. Retrieved 20 April 2018, from https://www.ibisworld.com.au/industry-trends/market-research-reports/health-care- social-assistance/general-practice-medical-services.html
May, C. (2017). Taking the pulse of general practice. Pursuit. Retrieved 20 April 2018, from https://pursuit.unimelb.edu.au/articles/taking-the-pulse-of-general-practice
O’Connor, S. (2015). Top 5 Risks During an EHR Implementation. Adsc.com. Retrieved 20 April 2018, from https://www.adsc.com/blog/top-5-risks-during-an-ehr- implementation
Raposo, V. (2015). Electronic health records: Is it a risk worth taking in healthcare delivery?. GMS Health Technology Assessment, 11(02). https://dx.doi.org/10.3205/hta000123
Saunders, C., & Tierney, L. (2011). A Guide to Understanding and Working with General Practice in NSW (1st ed., pp. 06, 36-42). Sydney: General Practice NSW. Retrieved from https://nada.org.au/media/14525/and145_gpnsw_guide_web.pdf
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