JAN RADFORD: We’re doing a little bit in this area but it’s new, and how do you sustain it and then use it for the greater good? There are some projects we’ve just started to work on but it’s a matter of slowly progressing the whole thing because you’ve got to make sure that patient records are handled with very good care. So the data governance has to be right.

CD: Can you explain what it is you’re looking into?

JR: When I started as a GP 31 years ago, it was all written down and filed away. It’s slowly crept in that electronic records have become more and more used and are now really the norm in Australian general practice. Each country has become electronic in that sense at a different rate.

CD: What is the current situation in Australia?

JR: The My Health Record is an attempt to take some of that information from a patient’s file and put it up there in the cloud for people to look at, but that’s recent, and also, that’s only a small part of what’s potentially in the record. Legally, records belong to the patient, however, the GP is the custodian and the generator, generally, of the records. Things have to be put in certain parts of the record. Blood pressure goes in one spot, your weight and height goes in another, medications in another. Because all these things can be put in particular areas in the record, you can take them all out and average them.

CD: So you’re using it as anonymous statistics?

JR: Absolutely. It’s de-identified, and all of this has gone through ethics committee after ethics committee, as it should. So patients’ identities are not there, but general things like the region they live in, how rural they might be, their age, gender, their status as an Aboriginal/Torres Strait Islander person, where they live in terms of their degree of wealth, just based on postcodes. All of those things can generally be appreciated. So the big pictures can be painted.

The next step, which we haven’t done yet in Tasmania, is use general practice record data and link it into other data sets. For example, if you’re a GP patient and end up in a hospital, say you had a stroke, and then you were discharged - in and out of hospital is a piece of information about you. Potentially, with a third-party trusted unit, you can actually get a code that will link that patient out in the community before and after the stroke with the event that happened in the hospital. So if we had a large number of patients, and, on average, this is what their health looked like - what’s the water quality like in that region, what’s the air quality like? The stats are that 85 per cent of people in Australia visit their GP on average once a year. So we can start to build up those pictures of the health of a region.

CD: Is this happening anywhere already?

JR: I went to the Royal Australian College of GPs conference recently in Sydney and we had this amazing talk from this very inspiring man who used to be a surgeon and then he turned to public health, called Harry Burns. He talked about Scotland, where he’s from. They get the health data but they link it to educational outcomes, correctional prison system data, the poverty levels. And so what they can do is measure improvements and outcomes.

Like us all, they understand it’s the kids. As a GP, I get to see a child before it’s even conceived in the sense that I get to know it’s parents. Then you follow the pregnancy, and then there’s the baby, and then it grows up. So, if you can actually understand there might be some vulnerable families in your community, you can target care to them, and you might end up with a better outcome for that child, who doesn’t sort of get lost in the system and end up with educational problems and so on.

CD: So would this data be used for preventative health initiatives?

JR: Primary prevention is really starting at that young age - eating well, exercising well, mental health issues, are all laid down then. Then, once you’ve got the problem - you’ve got to 40 and the doctor’s just told you they’ve diagnosed you with high blood pressure, then we’ve got to try and do things to bring it back to a target because we know if it’s above that target, you start hurting things, your arteries start to build up plaque, you start to affect your kidneys, you might affect the chance of having a stroke because of those arteries, you might affect the chance of having a heart attack because of those arteries. That’s secondary prevention.

CD: And what role does the data collection play here?

JR: If you’ve got numbers and stats to help you all the way, you know where you are. If you don’t measure it, you don’t know where you are. It’s the beginning perhaps of a journey that will keep going.

CD: How far off do you think that is - tracking people in and out of hospital and in the community?

JR: I think we’re another year or two away from doing that in Tasmania. We’re trying. We’ve got to get projects that someone will fund, and that hasn’t happened yet. We’re about to start a randomised control trial in Tasmania. I’m part of a three-university collaboration, and we will be doing some data linking in that project. So there will be some data from general practice linked into hospital outcomes.

CD: There are always the ‘Big Brother is watching’ comments. What do you say to those?

JR: It’s interesting because, mostly, the research that’s being done where they ask patients, ‘what do you think of this?’ and they say, ‘I thought you were doing that already. We want you to. We think this is a good idea’.

The idea is that when you design a system, you always have an opt-out option, because there are always people who are vehemently opposed, and that’s fine. I think they’re right to always be cautious and I think it’s always going to be best practice that an independent not-for-profit organisation, probably with a good government funding stream, that means they don’t have to go off and sell their soul to somebody.

CD: You’re originally from the North-West?

JR: I’m a Moriarty girl. My parents still farm there. I went to Wesley Vale Primary School and Latrobe High and Don College and then the University of Tasmania for my medical degree. Since 1987, I’ve gone back to Latrobe High to try and get the girls to think about science in year 8 so that they keep their options open. They might become an electrician or a plumber or something, rather than keeping their narrowed options of traditionally what are female careers. So we did that for about 10 years and then people thought, in fact, it’s the boys who aren’t engaging, so I’ve been giving prizes to all of the grade 8, and the best student in grade 10.

CD: What does the fellowship involve?

JR: It’s travelling and accommodation and conference subscription. So I’ve got five weeks to go and do this. I’m visiting England and the Netherlands and Scotland for the conference.

CD: When are you heading to Europe?

JR: The Royal College of GPs conference is in October, so I’ll build my program around that. Apart from that, I haven’t nailed anything down.

CD: Is there anything else you’d like to add? 

JR: I wanted to talk about practice-based research networks. There are almost 100 medical students here each year at the Launceston Clinical School. We have 40 to 45 fifth years and the same number of fourth years, and then some elective students. So those students all get placed in general practice.

About six years ago, we started getting the students to do audits on the practice data and the practice would say, ‘we’re interested to know how many women haven’t come for their pap smear and when they’re due’. So the students would work out a way of finding that out, send out other reminders and then help the practice manage another recount maybe 12 months later.