eHealthNews.nz editor Rebecca McBeth - February 27

Covid shared record causes ‘cacophony of complaints’

A new shared record system for Covid patients has caused a “cacophony of complaints” from GPs and should be “very much an option” for them to use, GP leaders say.

GP leaders spoken to by eHealthNews say the Covid Clinical Care Module (CCCM) is not fit for purpose and is creating more work and stress when GPs are already exceptionally busy dealing with the high volume of Covid-19 cases.

The CCCM is an iteration of the Border Clinical Management System, which was developed for use in Managed Isolation and Quarantine Facilities and is a modified version of the indici practice management system.

All Covid-19 care in the community hubs, general practices and some other healthcare providers are able to access the CCCM.

President of the Royal NZ College of GPs Samantha Murton hopes the system can be improved over time to make it useful during the next Covid peak, but says for now it should only be used by GPs where they see fit.

She says it works well for people not connected to health services, who need to have their care coordinated by one of the community hubs. Also, for high-risk patients where it is likely they will need to interact with HealthLine or out-of-hours services.

“For GPs there’s a sense that we are obligated to use it, but it needs to be very much an option for practices,” she says.

Funding for Covid-related care is linked to tasks being input into CCCM, but delays in getting patients loaded mean a GP may have been caring for a patient for up to four days before they appear on the system.

The patient record starts from the day they are entered, rather than the day they test positive, leaving GPs to find workarounds to enter information such as initial assessments and other care.

“With the volume of cases now there’s a whole load of work being missed,” she says.

Murton says while the basic idea of CCCM is a good one, the system has been developed for one environment and implemented in a very different one, without the time to change it to make it workable for users.

“It’s an iterative process, but the problem is the number of cases is going up so rapidly that it can’t be changed fast enough,” she says.

Also, a number of providers do not have access, such as ambulance services and emergency departments, so there is not visibility from across the system of patient interactions.

Chair of the General Practitioner Council, Vanessa Weenink, says there has been a “cacophony of complaints” from GPs about CCCM.

“The system has not been built for the people working on the frontline and the implementation of it has very much alienated GPs,” she says.

A key issue has been that people self-reporting positive results from Rapid Antigen Tests via My Covid Record were taking a long time to be loaded on to the system.

Weenink, who is a GP at Papanui Medical, says that time-lag and general slowness of the system seemed to have improved over the weekend, but usability remains “tricky”.

“There’s multiple click throughs and drop-down boxes that don’t necessarily improve things and make it very clunky,” she says.

One page asks the GP to manually enter the date, type and location of each vaccination the patient has had and will not let them move on until that is completed.

“It took me a while to figure out that if I just ignore all the boxes on that page it’s fine, but that makes the entire page pretty useless,” she says.

Another issue is that the system does not ask for the patient’s consent to share their information until the final page and several patients are refusing consent, making the data input a waste of GP time.

“The user interface is not pretty: it needs to be tidied up and the concern is that it’s so awful for providers that it puts them off using anything similar in the future,” Weenink says.

“My concern is that a lot of us love the idea of a national shared care record and can see the benefits, but this system is such a poor introduction for most people and might really put them off.”

A Ministry of Health spokesperson said it is aware of some issues with the speed that new Covid-19 cases are notified in the IT system used by GPs to manage patients and is working through these to continue to optimise the system.

"CCCM helps connect care across providers supporting people with Covid-19, and support cases and their households to be able to access the care that they need. It is also being used in some areas to support payment mechanisms," the spokesperson says.