Additional requirements : Primary Care

Version 0.3, Etiene Saliez /

• Primary Care:
  • Make use of most generic functionalities described above, adding the following aspects.
  • Coordination role:
    • The GP has a coordination and continuity role.  At the primary care level, he his expected to look at every kind of health problem.
    • Of course it is impossible to go deep in every kind of problem and the GP may often need to ask the support of specialists.
  • Organizational model:
    • Most patients have a "referent GP", i.e. a permanent relation with one GP of their choice.  In some countries this relation is formalized.  In Belgium the Social Security recognize a "DMG-GMD" contract and pay one extra fee per year per patient, for the maintenance of the patient record.
    • Most GP work as independent or as members of small group practices.
    • The basic unit of thinking is the contact:
      • A contact is a particular type of the concept of Activity.  It may be a consultation at the office of the doctor or a visit at the home of the patient.
      • During a contact one or more problems are discussed, not necessarily all the problem every time.
      • In most western countries and for most independent doctors, the incomes are based on the number of contacts, as defined in Activities.  The work unit is the direct contact, regardless of the duration from 3 minutes to one hour.  There are no incentives at all for collaborations by means of telecommunications.
    • Gate keeping:
      • The GP has often a role as gate keeper, issuing a request for specialist advice or admission in hospital.
      • Depending on the country this gate keeper role is mandatory or not, but only encouraged with some incentives for the patient.
  • Access to information:
    • It must be possible to retrieve as well all what has been said during a previous contact, as well all what is known about a problem across several contacts.
      
      
• Virtual group practice:
  • Introduction:
    • A kind of intensive collaborative work between a small group of associated GPs, typically 3 to 8 GPs.  They keep their own office in their own houses, but they have easy access to the records of a common population of patients.
    • The patient is still in contact with a preferred GP, but if he is not available, the patient may go to one of the others who have access to the complete record.  
    • From a medical point of view 
    • Architecture:
      • A group practice is based on a common secured small server trough internet, available 24 hours a day.  This make use of the module about synchronizations.  
      • At local group level, normally 100 % of information is shared, although exceptions remain possible.  
      • Moreover seen from larger regional servers, it look like any other practice or like a small institution, like a mini hospital, sharing most relevant information, but not necessarily all information.
    • Evolution of group practices can provide continuous service even during week-ends.  This evolution is important for 2 reasons:
      • Young GPs are no more available during a very high number of hours per week, particularly because today more than 50 % of medical student are womens.
      • As a way to limit the load of emergency entries in hospitals, taking care of many simple situations which are not really great emergencies, and avoiding the higher costs of hospitals.