Interview with Dr Kerryn Phelps, AMA President, Radio 2SM - Discussion on reports on a software program used by medical practitioners that is passed onto to drug companies

And the answer is if doctors paid for it, they wouldn't have this problem. This is to do with information. But apparently, and we're told apparently, the information about the patient is not passed on merely the statistics. That's one of the issues.

Dr Kerryn Phelps is National President of the Australian Medical Association. Good morning. Have you worked with this software from the Health Communication Network, HCN?

PHILPS: Yes, I have. And the minister's spokesperson needs to get their facts straight because doctors do pay for it.

ROBERTSON: It's expensive, is it?

PHELPS: In the vicinity of about $5,000 for a practice. It's not cheap.

ROBERTSON: Gee, that's really expensive. So how does it work?

PHELPS: The way it works is that there's an increasing trend towards computerised medical records because of a number of reasons, convenience being one and safety being another, particularly for computer prescribing. And there are a lot of practices who are switching over in the initial stages to computerised prescribing and then onto fully computerised records for those reasons.

ROBERTSON: So what would you do if I went to see you and you had to make a prescription? You'd type it our on computer, is that right?

PHELPS: Into your records, yes. And then the computer would check for any interactions, which you do mentally anyway. Or you would check with your MIMS book. But mostly it would come from your own memory of drug interactions. This way the computer remembers the dosage that the patient is on. It remembers any drug interactions, any other drugs you're on, any warnings like pregnancy or breast feeding or renal problems - kidney problems. And then up comes you're prescription which anyone can read.

ROBERTSON: You put odd little notes there, as you do, normally in long hand which no-one can read of course, do you put that on the computer as well or do you still have your separate cards?

PHELPS: It depends on the practice. Some practices still have the handwritten notes along with the computerised prescribing but I think more and more practices are switching over to computerised records.

ROBERTSON: Obviously at some stage some of this information is uploaded to the HCN people, is that right?

PHELPS: It has to have the doctors permission to be uploaded and our understanding is what has been happening is that doctors are being asked to be involved in research projects if you like which involves some of the identified data going to the HCN. Now our concerns through the AMA for quite some time and we have warned government about this on many occasions is that without national privacy legislation there are very few limitations on what can actually be done with this data.

ROBERTSON: Before we go back to that, do you know what actually is going up when you uploaded? Can you absolutely be sure of what information is going up the line?

PHELPS: I don't think that's entirely clear at the moment.

ROBERTSON: Does that worry you?

PHELP: Yes it does. We've been seeking information through the AMA and we've been making a lot of representations to government about the whole issue of the privacy of electronic health records. One of our concerns when we saw this wave of corporatisation by general practice coming across the country was that we would be seeing data being the new gold, particularly health data is very very valuable for places like insurance companies and pharmaceutical companies and governments.

And that there should over rights in national privacy for health, which we don't have at the moment. We don't have legislation that covers these things.

ROBERTSON: Can up specify that no information be uploaded to the company?

PHELPS: I think you have to make the link and if the link is not made then it can't be uploaded.

ROBERTSON: But there's no obligation as part of the software arrangement is there that you --

PHELPS: No, absolutely not, no.

ROBERTSON: So how do they woo you to do that? Do they say would you like to censor information so we can use it for statistical purposes? I mean how do they woo you to actually send it up?

PHELPS: The attraction for doctors to be involved in anything like this would be continuing medical education points through their college.

ROBERTSON: I'm not with you on that.

PHELPS: Every doctor every year has to get a number of points up for their continuing medical education so that they can stay on the vocational register and it's part of their ongoing assurances that they are maintaining their updating and clinical knowledge I suppose.

ROBERTSON: So how does updating information, even though it doesn't refer to specific people in anyway assist? I would of thought that's just a technical thing.

PHELPS: Yes, you would think so, wouldn't you? There are difference categories of points and some of the categories of points you would be able to see why that had an educational value for doctors. What they're saying is that it's a matter of clinical audit. That you have a look at exactly what you're doing in your practice with it, whether it be antibiotics for prescribing or hypertension for prescribing or whatever and then there's feedback as to how you rate compared to other practices and so forth. So there's a whole lot of different ways that this is done.

ROBERTSON: So that's a big brother thing, isn't it?

PHELPS: Well, yes you could say that to the extent there is several big brothers out there.

ROBERTSON: Yeah. Wouldn't you resist that?

PHELPS: Yes, we have been very interested in what this stage (inaudible) going to and why it's being used and what the value there is to doctors and patients. And as I said we've been making inquiries and have not yet been satisfied with the answers we've been getting.

ROBERTSON: Is there anyway you can establish what information has been collected from a practice? Can you go the other end and say I would like to see what you've down loaded from this practice Dr Smith at Smithfield. Is there someway you can in your position inquire and get a reasonable answer?

PHELPS: At the moment we are not able to get that information but we would certainly be very interested in finding out.

ROBERTSON: Are there any (inaudible) powers?

PHELPS: In the AMA, no. And under the current lack of legislation and as I said we've been pushing and pushing for this for the better part of the last year. And basically been getting a brick wall in response. We are desperate to get some privacy legislation in place so that we can mandate things like privacy for patient's records.

ROBERTSON: Yes, you're quite right. I think the one useful thing of course is that if you find someone who's have too many pills going from doctor to doctor, is there something in place already for that, is there?

PHELPS: Yes, the Health Insurance Commission through the prescriptions. I mean the government has just made it mandatory for Medicare numbers to go onto prescriptions and pharmacists will not be able to provide patients with subsidies with their medications unless the Medicare number is on the script.

And one of the reasons behind this was to have some more controls over the pharmaceutical benefits scheme. But I think on the other hand, it's partly going to be about data collection as well.

ROBERTSON: Yeah but also about saving people from themselves. That seems to be positive in principle, at least that bit.

PHELPS: There is always some positives that go with the whole thing and there's always I think supposedly good reasons behind some of the plans that come up. And I mean one of the roles of the AMA as we see it is to try and look at the whole picture and see where there might be potential down sides and the privacy issue is one what we've identified right from the outset.

ROBERTSON: I'm with you on that. But of course if the Federal Minister says that a few people get it for nothing and he's that far wrong, it's not very encouraging, is it?

PHELPS: No it's not.

ROBERTSON: There's something else. I don't want to interrupt on this thing but in The Australian this morning this thing in fact came to my mind before this other was discovered. Patients will be able to read reports comparing the outcome of operations, hospital infection rates and the administration of medications. Now up to eight percent of the nation's hospitals, this will be available online.

I don't know about you Madam, if I looked at hospital records I couldn't ascertain whether one was better or not because infections all the time in all hospitals is part of life I gather. Is this going too much information to patients?

PHELPS: I don't know whether too many bureaucrats looking at those figures without a great deal of explanation will understand what it meant either.

ROBERTSON: Oh really.

PHELPS: I mean you'd have to understand a fair bit about what's actually going on in a particular hospital and whether they only see the more difficult cases or whether they've got a particular type of patient population. So there are all sorts of compounding factors. But that being said the AMA has always been and the medical profession generally been very open to accountability and to record keeping and to making sure that we identify any hotspots and do something about them in the patients interests.

What we don't want to see is this information being attached to particular doctors names because there are so many issues other than the doctor involved as to whether there is a problem for a patient or for a hospital or not. We have identified also, over the last year particularly, the extent to which our hospitals are under funded.

We need to see about $900 million over the next two years going into our public hospitals just to keep their heads above water. And one of the upsides of this sort of a plan might be to identify a State or a region where the hospitals under funding is impacting on patient well being.

ROBERTSON: Yes that's right. It's very complicated, isn't? And of course any surgeon, if it's a surgeon report he or she is not there by themselves. There's number of complications.

This move has been driven by the Australian Council on Health Care Standards. This is the national body which says hospitals to meet accreditation and licensing standards. It just seem to me - I'm not bright enough - and indeed if I was going to go to a hospital I mean I'm not in an emotionally equipped state to actually look at these things and say compare the infections with this one to another other one. I mean the parameters of a layman are almost childlike, aren't they?

PHELPS: Yes, you often don't have the luxury to be able to make that sort of analysis. And then what do you do when you say this is the only hospital where that particular brain surgery is being done.

ROBERTSON: It's more anxiety, isn't it?

PHELPS: Yep.

ROBERTSON: If the whole idea is literally to improve quality and not to have some sort of witch hunt then there are going to be some upsides. The down sides are going to be if the data is misused. And the way it can be misused is to start pointing figures at people, at individuals where the problems might well be beyond their control. If they're looking at the actual system and their infection control standards and their staffing levels and the way the technology works and those sorts of things, and they're prepared to actually put the funding behind the solutions, then that's not such a bad thing at all.

ROBERTSON: Who would do that by the way. You've just described allowances for funding, allowances for a lot of things. Does someone actually sit down with these figures and draw this assessment that you've just suggested, or not?

PHELPS: I think State Department's of Health do that all the time. And so to say that we don't actually have those statistics at the moment, not on the internet, is not correct. I mean we do look at those sorts of statistics all the time.

ROBERTSON: Overall assessments are done by someone who knows.

PHELPS: It's hard to say.

ROBERTSON: I mean if I were to say to you privately over a cup of tea, which are the good hospitals, which are the bad hospitals, would you know?

PHELPS: Yeah I'm a GP and GPs are the one's who see the good and the bad coming out of the hospitals.

ROBERTSON: But how do you know? Word of mouth or what?

PHELPS: Largely. We get reports from specialists that we deal with. We see the complications coming back from patients. But I doubt very much whether too many people will log onto the internet and be able to make such sense of the whole bunch of statistics.

I think if the organised medical profession and governments can use these statistics for positive benefit then I would say it was something good. But that being said I think hospitals particularly are way way behind in terms of their technology to be able to even come up with this data.

ROBERTSON: There are a lot of ifs in what you've said this morning, aren't there?

PHELPS: Oh there are.

ROBERTSON: Lots of ifs. Thank you for your time Madam, I appreciate it. Dr Kerryn Phelps the National President of the Australian Medical Association.

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