Influencia del texto

There are other aspects of computer use in rural general practice. The use of IT by GPs reflects the patterns of use in small business (Burgess, Darbyshire, Sellitto, Tatnall and Wenn 2003) and it seems that if general practices use IT then in many cases it is for perceived cost savings rather than for adding value (Burgess and Trethowan 2002) “General practice business generated a gross business income (before deduction of practice costs) of $2,836.3 million and had an operating profit before tax of $778 million. This represents a margin of 27.6%. By far the greatest proportion of income came from fee for service medicine. GPs’ average medical service income was estimated at $124,992. The average business income per medical practitioner employed (without deduction of expenses) was $136,200. Average wages and salaries paid to medical practitioners employed by general practice medical business was $51,200. (General Practice in Australia 2000:172) in light of these figures it is little wonder that the adoption and use of IT/IM accelerated when support for IT/IM was implemented.

In viewing general practice as a business the Department of Health and Ageing (DoHA) offer a clear recognition that in the past few years the concept of general practice as an industry is very clear. It functions on three levels – that of the individual practitioner, that of the practice, and that of

the profession overall. (Dept. of Health and Aged Care 2000). The Department are not the only ones to be taking this view for Allied Medical Group (2007), (a company that supports general practice by providing business services) provides us with this as a mission statement –

Allied Medical Group is committed to providing premium quality facilities, services and personnel in order to facilitate the optimum standard of care to patients.

Allied Medical Group is also committed to providing a premium working environment for medical practitioners in order to assist them in achieving their professional, personal and financial objectives.

http://www.alliedmgp.com.au/

In Australia, an annual study examining the use of computers and electronic commerce in small and medium businesses (Telstra Corporation and NOIE, 2000) defines a small business as having 1-19 employees and a medium sized business as having 20-200 employees. It is not surprising then that general practice clearly falls into the small business category. A total of 56,780 persons were employed in 11933 general practice medical businesses when account principals, employees and contract workers were taken into account. (ABS 1997)

General Practice as Small Business

In General Practices information management focuses of the better management of information that can assist in promoting improved clinical, patient and practice outcomes. Information management in general practices can provide additional functionality that may be available and not being used such as:

• Electronic data availability and exchange (eg on-line pathology/radiology ordering and reporting).

• Patient information databases such as patient registers including patient age, sex and disease; recall and reminder systems.

• Practice administration and management such as electronic staff rosters/pays, billing and claiming; stock ordering on-line; GST statements.

• Contribution to research activity such as adverse drug reporting; electronic contributions to approved clinical research activities.

• Electronic diagnosis and treatment support such as drug-drug interaction alerts; patient medication and clinical histories.

A situation analysis carried out by the GPCG (2002) suggests that Information Management in General Practice should focus on the better management of information that can assist in promoting improved clinical, patient and practice outcomes. The change management required to promote this agenda can be broken down into the following challenges:

• Insufficient information has been passed to stakeholders (Micro).

• Communications are not yet adequately coordinated (Micro).

• Specific messages are still being targeted for each audience (Micro).

• Little understanding on the impact of Information Management in General Practice on target groups. IM in General Practice seen to be driven by Information Technology rather than GP Business Needs (Macro).

• Modest buy-in and support from stakeholders (Macro).

• Opinion leaders need to communicate the benefits to key stakeholders (Macro).

But all of this assumes that the technology will be used in rural general practices, hence this research project to identify and model IT adoption by rural general practices. It is clear some progress has been made in terms of adoption (as tables 1 and 2 pager 15 and 16 show) however in light of viewing general practice as a small business, many general practitioners and

their practices still do not foresee any benefits for their own practice even while the potential efficiency and quality gains for both patient and government are more obvious. Many general practitioners are more than happy to leave the “hard stuff” to their staff. Further to this, in a review of GP web sites in Australia Burgess and Trethowan (2002) determined that a lower proportion of general practices have web sites than small business, and that the web site was used mainly to display simple information such as the physical location of the practice, contact details, email addresses,

information about the practitioners, and latest news. A very small percentage provided automated services, such as automatic recalls or the ability to make online appointments.”(Tatnall et al 2003) In re-doing this web search in 2007 I found that web sites had changed very little.

Barriers and Opportunities

The literature around the area of small business and information technology is rife with what is now a fairly accepted list of ‘barriers’ to the successful

implementation of IT in small businesses. These barriers typically include (Management Services, 1997; Igbaria et al, 1997; Pollard and Hayne, 1998; McDonagh and Prothero, 2000):

• The cost of IT

• Lack of time to devote to the implementation and maintenance of IT

• A lack of IT knowledge combined with difficulty in finding useful, impartial advice

• Lack of use of external consultants and vendors

• Short-range management perspectives

• A lack of understanding of the benefits that IT can provide, and how to measure those benefits

• A lack of formal planning or control procedures.

Rural Small Businesses

Some of the problems facing rural small businesses are similar to those facing small businesses in developing countries. Small businesses that are located

away from major cities and towns face access issues similar to those already mentioned.

A study of small businesses in the rural areas of the United Kingdom

(Management Services, 2001) indicated a wide and growing use of computers and the internet, but a lack of ISDN or other broadband services had restricted access in some remote areas. It was felt that there was a lack of opportunity to develop familiarity with computers. It was thought that there could be a possibility of using local schools for acquiring these skills, but difficulties related to clashes with working time, distance, travel time and the relevance of the courses offered needed to be addressed.

One of the benefits that the internet may provide is remote access to many desired IT resources, such as training. Access to the internet can also provide small, rural businesses with greater opportunities to trade across borders though the reduction of transactions costs (Gallagher, 1999).

Skilful use of the Internet can create opportunities by giving farmers, small business people and communities the capacity to present a regional image to the world, create focal points for inquiries about local businesses and their offerings, create global businesses and develop new products and services.

(Gallagher, 1999)

Interestingly, a year 2000 survey of Australian small businesses revealed that 29% of metropolitan small businesses had a web site, compared to 20% of rural small businesses. The main reason given by rural small businesses for not having a web site was that they did not have access to the skills needed to design, build and maintain a web site (Telstra Corporation and NOIE, 2000).