According to the annual divisions surveys of GPs (2000, 2002, 2006, 2007) there has apparently been widespread attitudinal acceptance of computers by GPs. By contrast, in a study commissioned by the Commonwealth Department of Health and Aging, (GPSRG 1992) GPs were asked about the extra demand that computerization places on them. It appears that there is good evidence in this study to show that extra demands may be due to the manner in which the innovation has been presented to them - as a necessary tool to achieve improved health outcomes instead of as a peripheral skill which may be understood by those who implement technology and attend the computer labs. Computers in general practice may be little understood particularly by older GPs and sometimes resented by GPs who have had to accept it and the additional skills to be acquired. However anecdotal information would point to another situation for GPs particularly in rural areas. In the General Practice and Primary Care (1999) survey it was stated that: “Although it can be argued that the use of computers has contributed to the more effective management of information at population level, there is little direct evidence that the general use of computers improves efficiency at individual GP level…….nor evidence that clearly shows that rural GPs have benefited”
For over two decades GPs and general practice have been encouraged to use IT, (PHCRIS 2003, 2005, 2006), but very little still is known about the exact way that rural GPs and their practices use IT. The variations of results shown in tables 1 and 2 on pages 15 and 16 are witness to this. It is important to capture why use of IT occurs in the manner that it does. Research on how general practices use IT has concentrated on providing baseline data to inform about future initiatives but very little information exists about the actual process general practices pass through in decision-making about IT or about
the enablers and barriers to use. The question then is: if the IT products have been developed why are some general practices reluctant to use them?
The General Practice Computing Group study (2001) recommended increased training and technical support, and, also recommended in their 2001-2005 strategic framework for IT/IM that the vision for Australian general practice is “The vast majority of Australian general practice will be utilising structured, standards-based information technology and
management systems to provide improved patient care” (GPCG 2001) The 2001 US Institute of Medicine report on American Healthcare indicated the top IT priority over the forthcoming year would be deploying internet technologies.(Health Management Technology 2001). But there is a nagging situation for general practice in rural areas which is that they service greater numbers of patients than urban general practices, and geographically these patients are spread over a broader area. This has an impact on the amount of time available for learning new skills.
Another nagging issue is that of quality of infrastructure to support such networking - eg access to effective broadband connections. As long ago as 1999 Richards et al (1999) suggested there is evidence that many GPs are being encouraged to adopt the Federal Government’s policy supporting implementation of an online approach without have the necessary IT infrastructure to support it (this includes in house office support). This was reiterated at a PHRIC research conference regarding primary care in June 2003 where the concern regarding reliability of services to support
interconnections was voiced by several GPs, this seems to be a fair enough challenge in light of the fact that the government at the time was wanting to continue to sell of Telstra.
The issue here is the ability of a private provider to sustain the infrastructure needed. A good example is the ability to download information in rural areas
in the same manner that can occur in urban areas. Another example comes in the form of a question “How can rural GPs, who are already overburdened with workload, sustain yet more work in terms of data input?” Access to effective broadband continues to be an issue even though rural GPs have now been able to access satellite connection via a scheme started in 2004 by the federal government. In regard to these connections it appears that the provider is of the utmost importance in providing reliable download ability.
These situations are challenging to GPs but there has still been no study of usage in real time. Policy and Frameworks rely on reports, not observations, of what is happening at the coalface. In a review of PHCRIS databases it was found that of the 245 studies reported only 2 studies were of a qualitative nature. In a further review of studies being undertaken and reported by Divisions of General Practice, it was found that while there is a flourishing movement toward qualitative research the actual studies are more about clinical matters with very few having a qualitative nature. Research of a qualitative nature is only just emerging (Flinders University 2003). Only 34 studies of Australian general practice were found to meet the guidelines for credible qualitative research (Russell and Roach 2003). While this was a study that involved a narrative review of Medline referencing qualitative primary care research articles, it is an indication that the full potential of this type of research has yet to be reached (Russell 2003).There is difficulty in finding data on research in the health care fields mainly because it is scattered throughout many databases, there is a call for a national register of research being undertaken. No studies are being undertaken to assess the impact of IT/IM on GPs, nor of how they actually use IT/IM. Currently there is one study being conducted by Melbourne University assessing the way the GPs use computers in the doctor - patient - computer triad.
In rural general practice, information management focuses on the better management of information that can assist in promoting improved clinical
outcomes, and dissemination amongst regional medical professionals (Medical Economics 2001; Strategic Plan CHDGP 2003). This situation has not changed even though the approach to achieving it has – the strategic plan for CHDGP 2007 repeats the goal for support as above. Supposedly, this can be transferred into improved patient care. But in a real sense, is it reasonable to require rural general practice to do even more in light of the burden they carry at this time? Despite this situation rural general practices were reported as stating that computers and use of computers is high on their agenda. (Batterman 2003)