Gp's not allowing others to add diagnosises


Within my trust I have been informed that GPs are the only ones who can add a diagnosis to systemone. This is because of an old belief the GP owns the patient record and adding a diagnosis will effect their funding. They obtain their reports but pulling satistics from system one counting a number of codes. However they do this for all codes, including codes entered interenally and externally from their practice. If someone adds a dianosis outside of their practice, they GP sends a mark in error request. The Gp has the ability to run systemone reports internally.

I want to know. Are other people encountering this? How are they dealing with it? Is some reason im missing why this is still happening. It is my belief unless the GP has been making the diagnosis they should not be adding the code. I also belief it delays the updating of the patient record.

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Hi @Mpriestley and welcome to OHH. I’m a GP and also used to work in hospital medicine so I have several viewpoints. I’m also a specialist in healthcare tech and GP systems.

You ask a very good question about entering diagnoses. The reasons are mainly historical - GP records were never really designed to be a single shared record, used by many other professionals, but that is how they are now used. Partly the reason GP records are used as the ‘single’ record is that they were more digitised and complete than other records eg hospital records.

Over time there will need to be a development and maturation in how we use records, and the systems will need to allow entry of diagnoses from other professionals but enable differentiation of these from GP-entered ones. You’re right that GP remuneration does depend on the record being accurate, so this is why GPs may have strong views about who can enter new information.

So it’s got historical basis but it isn’t actually an ‘old belief’, it still applies. GPs definitely don’t ‘own’ the patient record, the data definitely belongs to the patient.

The healthcare technology world has still not properly solved the problems of:

  • how to manage multiple different clinicians’ priorities about what should be in a ‘single’ patient record
  • where to store this ‘single’ patient record
  • who has the authority to make and unmake a diagnosis in a single record
  • how to manage organisational ‘private notes’ which may have more to do with the organisation than the patient

As you can see, it’s far from sorted. But if you are interested and want to find out more, then this forum is a good place to ask questions, as is the forum, the Faculty Of Clinical Informatics, etc

Dear Mpriestly, your question touches the sensitivity of data. I have been working 40 years as a medical specialist, all over the world, and know from experience that medical charts contain important information. Unfortunately, they usually are far from complete (US EPD’s are incomplete in over 98%), contain a lot of ‘old stuff’ or erroneous diagnoses and nonsense. The copy-paste culture has added to this. So, it is quite understandable that a GP does not want someone to mess up his files.

Medicine is not a digital science, to quote WIlliam Osler ‘Medicine is a science of uncertainty and an art of probability’. Daily, every doctor is insecure about one or more patients he encounters. So, ‘one does not want garbage data in’, knowing the result, right … ‘garbage out’.

For lay people the thinking of doctors is difficult to understand. However, you may understand better just typing in fever and diarrhea and see what pops up in f.e. I have written a blog where you can follow the process and see for yourself how hard it is to diagnose properly. (How doctors think. 1) In this ‘simple’ case over 800 possible diagnoses have to be considered, over 30 remain, only one is the true diagnosis. For programmers it is a read worthwhile.

Another issue is the problem of how to codify diagnoses. ICPC for GP’s has 3 codes for ‘hypertension’, ICD10 over 70, Snomed has far more, over 700!, hits on ‘hypertension’. If you view that online yourself, it may us help understand why Medical IT is far more complex then just cross referencing simple db’s, and we have moved, like physics, towards a probabilistic approach. Fill up all gaps in the IT architecture of Medicine will keep us busy for several centuries. Lets start with what is possible with our humble, compared to our brains, computers.

I hope you remain trusting your doctor because you do not have better than that.

Regards, Hans