November 29, 2004

Help for Doctors at Hand

Some New Zealand GPs already use computers to help them diagnose illnesses and treat patients. One day all doctors might. By Reuben Schwarz.


THE Health Ministry is warm ing to the idea of using computers to help doctors make clinical decisions. Richard Shiffman, a Yale University professor advising New Zealand's Health Ministry, says doctors need "electronic decision support" in their practice rooms to help them quickly access information about illnesses and treatment.

"Doctors are overloaded with information right now. There are thousands and thousands of articles published every day," he says.

Professor Shiffman says there are differences in how treatments are dispensed. This can lead to the overuse of some drugs such as antibiotics and the under-use of others, like aspirin prescriptions for patients recovering from heart attacks.

"Sometimes doctors forget or they're too busy," he says. "Electronic decision support helps them to make sure they do the right thing."

Professor Shiffman envisages a computer in every consulting room connect ed to the Web. Doctors would type in a condition such as asthma, and the system would display medication guidelines for different symptoms.

A more advanced system could an swer specific questions about diseases.

The ministry invited Professor Shiffman to New Zealand to advise on the future of healthcare.

The debate over the extent to which "expert systems" could or should be used to aid diagnoses is controversial, with some fearing reliance on IT could be used to pursue other agendas -- such as to promote cheap treatments over expensive ones.

Professor Shiffman concedes doctors do more than weigh up symptoms. They also look at patient and family history and psychology.

"Patients' attitudes, beliefs and preferences have to be taken into account. That's why this machine will never replace the physician," he says.

NEW ZEALAND already has a product similar to that which Professor Shiffman proposes -- Auckland GP Ashwin Patel's My Practice software. The product has finished trials and is available for sale.

My Practice handles lab reports, patient notes and specialist referrals, as well as dispensing advice to the doctor. Information and alerts pop up to remind the doctor which tests or medications are appropriate.

Dr Patel says the system is designed to bring up only relevant information so the doctor doesn't begin ignoring it.

"It's delivered in a doctor-friendly way. The doctor is getting a small amount of relevant information rather than a lot of bland stuff."

The software is priced on a subscription basis, starting at $200 per month for a solo general practitioner.

Harley Aish, a GP in Auckland, uses an earlier version of My Practice and says his surgery wouldn't be the same without it. "It's unbelievably useful. It's very hard to be an expert in everything," he says.

Dr Aish uses the system to treat chronic diseases like diabetes because it displays the latest lab results, blood pressure, weight and advice on medication.

"I wouldn't go back to paper, or even a computer that just records things."

Dr Patel says some outpatient clinics in some Auckland hospitals are looking at buying the software. He's planning to export it with his partner, established Kiwi health software supplier Orion Systems.

Professor Shiffman has himself developed a computer program that suggests clinical guidelines for treating childhood asthma.

The software tells the doctor which information to collect, then uses that to suggest medications and print off a prescription.

The doctor, however, can still override the program and print off a dosage they think is most suitable.

The district health board in Counties-Manakau has been using My Practice, as well as practice management software from Intrahealth and MedTech, as part of its strategy to fight chronic disease.

Phil Brimacombe, chief information officer of Counties-Manakau DHB, be gan integrating the software three years ago to create the Chronic Care Management programme.

GPs in the programme enter "a whole raft of medical indicators" into the software when they treat patients with diabetes, cardiovascular disease, or recurring heart disease.

The indicators are processed by the DHB's program, which searches patient history and sends back a response in 5 seconds.

"It provides a better outcome for the patient," Mr Brimacombe says. "GPs can quickly find out if the patient has the potential to get worse, and can head off problems before they develop."

This is particularly true for diseases that can rapidly get worse. For example, diabetes can cause limb loss if not closely monitored.

Kidslink -- a project to better integrate maternity wards, GPs and Plunket in Counties-Manakau -- was started at the same time as the chronic disease programme.

It tracks children from birth to two years old, reminding when to give immunisations and when to perform different medical checks.

If these are not recorded at the proper time, the system sends out an alert.

"If children have bad health when they are young then it often leads to health problems later in life," Mr Brimacombe says.

Kidslink gave birth to the National Immunisation Register launched in July 2004, which handles the management of immunisations for patients from birth till they are 20.