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No room for doctors in the digital revolution


Dr Ron Elisha   more by this author
30th Jan 2009

A MERE quarter of a century after the inception of the personal computer, the little blighters have finally wormed their insidious way into that last bastion of pointless documentation – the nursing home.

Wherever I go now, I must remember not only the code to get through the gate, and often another code to get through the door, but also my username, my password and then a string of clicks and commands to get me into the software.

For someone who attends dozens of different aged care facilities per week and whose brain is rapidly approaching the state of those institutions’ residents, this represents no inconsiderable hurdle.

It would’ve been too much to expect, of course, that there be some sort of standardised approach to the use of software throughout the Australian aged care industry. Such a move, no doubt, would have been viewed as dangerously sensible.

So what we have instead is a profusion of cutely titled software packages, ranging from I-CARE to Leecare to TopCare to Thrucare to H-care and, finally, to the software endorsed by Ms Roxon’s department, Don’t-care.

Don’t-care is a package specifically designed to run on an underfunded health system. Devised by a 19-year-old whiz kid operating out of a tenement kitchen in the Rwandan capital, Kigali, it is powered to deliver fourth-world health care at third-world prices.

Each Don’t-care package allows for the logging-on of only one medical practitioner, while providing unlimited access to nurse and allied health practitioners. This ensures that the system is not flooded with doctors who, as we know, have been found to be increasingly superfluous in the efficient delivery of health care.

It is rumoured that Don’t-care II will automatically block the logging-on of all medical practitioners.

Ingenious in its design, Don’t-care ensures the progressive fragmentation of the aged care industry, providing for cheap, ignorant clinical decision-making at the touch of a button.

In accordance with the fact that Don’t-care is designed to deliver documentation at the expense of care, it was felt that the term “Progress Notes” created unrealistic expectations with regard to patient prognosis.

Practitioners, therefore, are asked to enter clinical data under the manifestly obvious yet less oppressive title of “Care & Lifestyle”.

The latter presents a drop-down window offering two options: “Simple Bits”, where nursing staff can enter pulse, BP, temperature and comments on apparel, hair care and hobbies; and “Complicated Bits”, a secure section where medical practitioners are encouraged to enter data that no-one else understands.

Access to the latter will be denied to nursing staff in order to ensure that it does not hamper patient mismanagement.

In this way, it is hoped that Don’t-care can go some way to redressing the hitherto lopsided influence of medical practitioners on patient care, thereby fostering an approach that is truly team-oriented.

It is expected that Don’t-care III will incorporate clinical input from kitchen staff in addition to a learning module that will enable domestic pets to be involved in end-of-life decisions.

This will eliminate the need for regular defragmentation.