Table 1 Exemplar quotes presented by theme and sub-theme

Knowledge about medical practitioner registration and professional learning

Regular Training and Continuing Professional Development

It’s usually like you do your professional development, you’re like learning about new research in health, and things like that.

PCP_03 (20yo, high level of health service interaction)

My understanding is they have to get a certain number of education points or something, I don’t know exactly what the jargon is, for them to be able to continue with their licence…That’s all types of medical practitioners, whether they’re physicians or general practitioners or specialists or whatever.

PCP_05 (69yo, high level of health service interaction)

I would expect that they stay current with medical developments, particularly in their specific field of expertise. And that would also be just professional development activities, which might be include relating to internet or medical records online and things. Things they need to be aware of, and things change.*

PCP_09 (65yo, moderate level of health service interaction)

Re-validation

there should be, look, as there is with licences to drive cars, if you’re going to be licenced to cut someone open and work on their heart, there probably should be a point where you’re re-confirmed to assure that you can still competently perform that operation. Whether that’s every two years, five years, I don’t know. Probably depends upon the person, the age, whatever. Yeah, they should be re-tested, if that’s the right word.

PCP_04 (60yo, high level of health service interaction)

I would expect that there’d be regular annual big sort of reviews in the practice in their accreditation… And I would expect they’re obliged to indicate on a regular basis their awareness and adherence to any changes in legislation or policies or anything that might come out either from the federal health departments, as well as their own peak body.

PCP_06 (60yo, low level of health service interaction)

Conferences and Seminar Participation

I think they have to go to seminars but I’m not aware that their practise gets checked out. Like I say, a nursing home would be checked out.

PCP_08 (63yo, low level of health service interaction)

I think absolutely. I think it’s a necessity in most professions and even if it wasn’t, I think it would be quite slack of a medical person, any medical professional not to want to keep up with what’s current, so there’d be webinars and Zooms and all those things for people that can’t get into face-to-face training.

PCP_07 (63yo, high level of health service interaction)

Reading Journals

Well in the past, probably attending conferences, reading journals.

PCP_02 (74yo, high level of health service interaction)

I think it could be everything from reading journal articles, seminars and these days, webinars.

PCP_05 (69yo, high level of health service interaction)

Peer Feedback and Discussion

I think peer discussions. If we’re talking about general practitioners, for example, peer discussions either within a group of practitioners or something that’s facilitated by the local PHN.

PCP_05 (69yo, high level of health service interaction)

I would expect that they would be doing a far bit of professional reading and just discussions with other medical professionals in the field.

PCP_09 (65yo, moderate level of health service interaction)

Mandatory Training

I think certainly they should be getting whatever comes from the peak body in their specialist area. And I think they should, may not be, but I think they should be engaged in any areas of specialisation…I would hope there’s some obligations, that would oblige them to keep in touch with emerging research and trends.

PCP_06 (60yo, low level of health service interaction

The employer or whoever, whatever medical group they’re working with would provide professional development activities.

PCP_09 (65yo, moderate level of health service interaction)

Secondary Use of Electronic Health Data

Information sharing between health professionals

I would like to think that in the perfect world that would be happening all the time, there’d be a collaborative approach, and that the GP who I see every week would be fully aware of the operation I had and the outcomes, and why this medication was prescribed. It doesn’t happen, probably because of time constraints, but I would think that would be the most desirable situation.

PCP_04 (60yo, high level of health service interaction)

Health care organisation service provision

I think I would hope that it helps them make sure that they’ve got the right mix of expertise … And it may highlight either at a practice level or at a hospital level, that they might have a gap in up-to-date knowledge.

PCP_06 (60yo, low level of health service interaction

I would think healthcare providers, they’re going to have the data for the people within their catchment. So they will know how many people have been admitted to hospital and how long hospital stays are, et cetera, because they need to work out their costs and insurance levels.

PCP_09 (65yo, moderate level of health service interaction)

Identifying population health trends

I think also geographically there may be a useful in terms of particular illnesses appearing that they weren’t expecting that there will be an emergence of a particular condition amongst kids or the community. There’s often those outbreaks you would here about in regional health groups. There’s an emergence of cases that may not otherwise look connected. And I would hope that doctors and health professionals could be sorted it out looking at that data.

PCP_09 (65yo, moderate level of health service interaction)

Health messaging

I think there’s a whole range of ways that that sort of data can be used. Again, it’s de-identified data, so it’s about public health messaging, epidemiological, infectious disease stuff, as well as building the capacity of the clinician to treat that condition better.

PCP_05 (69yo, high level of health service interaction)

Reflective Practice and Learning

I think I very much support it. I think that they should be doing that.

PCP_02 (74yo, high level of health service interaction)

I suppose like professionally, doctors and health professionals that reflect on what they’ve done, and how they’ve done it, and whether or not they did a good job or not. So you’d always kind of be reflecting on that hopefully, so then you know, actually provide good care. Yeah. So I’d expect them to be reflecting on what care they provided and things like that.

PCP_03 (20yo, high level of health service interaction)

Yeah. So they’ve entered me. I’ve been there two days, had the procedure, I’m fine. I’m to think about them looking at all of my information and how they’ve used it? Look, I would totally encourage it, I think. I don’t think they do it enough, as far as I can see. I think they should do it a lot more often. I think it’s probably one of the many very basic teaching tools they have at their disposal to educate themselves and those around them, and certainly those they’re training.

PCP_04 (60yo, high level of health service interaction)

Look, I don’t have a problem with that because the fact that they’re called health professionals underlines the whole professional stuff. I think most health professionals understand about patient confidentiality.

PCP_05 (69yo, high level of health service interaction)

I think that would be perfectly reasonable. And I think that’s pertinent again, to really get gaining best outcomes for the patients.

PCP_15 (45yo, high level of health service interaction)

Absolutely fine. Yep, because it’s often not until patients leave that doctors have got time.

PCP_07 (63yo, high level of health service interaction)

Oh, yeah. Absolutely. I’m sure there’s always things they can learn at looking back. Yeah.And perhaps, consulting with other doctors or healthcare professionals about different ways they’ve handled different things.

PCP_13 (58yo, medium level of health service interaction)

I think it’s great. Like for them to look at that [data] and take that seriously I think it’s fantastic because it means they’re really interested in what has happened and you’re actually review it. So there has to be better for other patients will come in.

PCP_06 (60yo, low level of health service interaction

Absolutely fantastic, because I’m going to benefit from it when other people do it… If they do it to my data, another person is going to benefit from it, and that makes me feel good. You know, warm fuzzies.

PCP_11 (61yo, high level of health service interaction)

I think it’s fantastic. I think that’s just a dream scenario that people from the teams because everyone brings their different specialist knowledge and together they’re probably going to see things that one doctor by themselves may not see. So I think that’s fantastic.

PCP_06 (60yo, low level of health service interaction

I would agree with that. A team reviewing things collaboratively would be a very good thing I would think.

PCP_11 (61yo, high level of health service interaction)

I’ve never thought of that. I have never thought of that. That’s something that I hadn’t thought of. Again, if it’s for the betterment of people, I don’t think I’d have a problem. I’d feel absolutely fine about that.

PCP_07 (63yo, high level of health service interaction)

Again, if a doctor and his cohorts were looking for the betterment, I would like to be advised of that. I would like to be advised of that. As I said, again, if it’s for the betterment of people and patients, I think that’s okay.

PCP_07 (63yo, high level of health service interaction)

That would be fine. Because it will lead to a better outcome for an old patient. It’s part and parcel of a learning process… I mean, if you’re going to learn, they’ve got to be able to go through that data. They’ve got be able to.

PCP_14 (70yo, low level of health service interaction)

Factors that enable use of Electronic Health Data for medical practitioner learning

Guidance and funding from government agencies and peak bodies

I think they < governments and peak bodies> can be involved, they set kind of the guidelines for what you’re doing and how you’re doing it, and they could just say that, “This is what you should not, what you shouldn’t do,” things like that.

PCP_03 (20yo, high level of health service interaction)

I’d say it would be a major project by something like the < funder name> So yeah, some government or non-government organisation.

PCP_02 (74yo, high level of health service interaction)

I’d say really that should be government talking to the College < Name>, and letting the College < Name> manage that sort of thing, because they’re better able to understand the pressures…I think that’s going to be the better arrangement.

PCP_11 (61yo, high level of health service interaction)

Design of Clinical Information Systems

I don’t think they should be wasting their time on stuff that doesn’t need that level of attention paid to it. I think we can be using AI and some of the analytics to be doing a lot of that kind of work and just pumping up anomalies. But in that case, then they should be taking that look at that 1% of cases to try and improve the state of things.

PCP_01

Basically the way that medical records are stored, there’s very little tracking of what’s changing over time. So just manually looking back through someone’s record is probably not going to give you the full information. You need something to analyse that data time targets or they show it on some sort of graph or something like that, to be able to know which is the relevant data you should be looking at.

PCP_02 (74yo, high level of health service interaction)

Engaging Patients and or/Peers in Review

perhaps you could even involve the patient in the reflection process, I think that would make sense. And if they have something to think about and to improve, and could probably just like also ask the patient like, “What did you think?” And something like that. And probably also train about using technology properly and things like that, and how you use the data and what you’re doing with it. Yeah, transparency. You should have it be transparent that, “This is what we will do.”

PCP_03 (20yo, high level of health service interaction)

Absolutely. I’m sure there’s always things they can learn at looking back. Yeah.And perhaps, consulting with other doctors or healthcare professionals about different ways they’ve handled different things.

PCP_13 (58yo, medium level of health service interaction)

Data Linkage

Correlate the data from different organisations. If somebody is living in Queensland and moved to New South Wales, they probably left most of the data behind them. So the doctor won’t have the historical records unless it’s coordinated nationally or even internationally when people move countries.

PCP_02 (74yo, high level of health service interaction)

Challenges using Electronic Health Data for medical practitioner learning

Reflecting on patients outside individual scope of care

Like you can reflect on what you did with a patient, like you wouldn’t be reflecting on what someone else did with the patient. So you’re just reflecting on what you did.

PCP_03 (20yo, high level of health service interaction)

I think when it becomes an aggregate experience, it should be de-identified. But they can move away from that fine relationship of trust that you established with a treating doctor to an environment that sort of echoes more public and I think it would have to be de-identified. I had a core feeling that you do have a great trust with the treating doctor and that’s what you buy into in a way. But I think once it goes to the team, I think it should be, you know, of any age and background and family history that sort of stuff. I think it should be de-identified. That the concern would be once your name becomes public, that’s where you have no idea where it will end up.

PCP_06 (60yo, low level of health service interaction

If it was a practitioner that was working with the patient. I wouldn’t say just any practitioner should have access to it…I think that they should certainly know the patient

PCP_02 (74yo, high level of health service interaction)

If it’s just that doctor looking at it themselves. Yeah, that’s fine. Yeah. But if it’s going to other doctors and whatever, those are better to be de-identified.

PCP_13 (58yo, medium level of health service interaction)

Limited time/no reimbursement

I think in general practise for probably 99% of things, they wouldn’t have the time to be able to do it, and certainly Medicare wouldn’t be funding them in any way to do it.

PCP_01

certainly, it’d be a good idea but I don’t know whether they’d have time to do it at the moment, they need some support to be able to do that I think.

PCP_02 (74yo, high level of health service interaction)

Caseload gaming

That’s a very vexed one which is, it’s a real problem…For instance, if you’re a surgeon specialising in an operation, which can have a reasonable mortality rate, and if you’re going to be judged on your excellence as a surgeon on your mortality rate, you’re probably less likely to accept patients who might be in that risk field. You probably send them off somewhere else, or just say, “Look, I don’t think I’ll touch you.” Because at the end of the day, you know that you’re going to be assessed through the hospital system and people are going to say, “This person’s had a 5% fatality rate doing this operation. He can’t be any good.” When it’s just as likely that the people that he’s operated on would all have died anyway, plus a few more.

PCP_14 (70yo, low level of health service interaction)

Inaccurate or incomplete data

I’d be very worried about it at the moment because I’m aware of the particular case, where several different specialists produced different records and only one out of the three made its way onto the discharge report. But the two didn’t. So, anyone who’s looking at that data afterwards probably got a very incomplete idea of what actually happened.

PCP_02 (74yo, high level of health service interaction)

Consent for secondary use

If patient is identified

I also wonder under what cases should that data be more broadly available, so researchers, pharmaceutical companies, health insurance companies. I would hate for a health insurer to have my specific data and up my premiums dramatically… But I could see that anonymized data could be very useful to any number of organisations in improving healthcare in general. So depending on the kind of organisation it is, I would be quite happy for people to have access to anonymized and rolled-up views of my data.

PCP_01

I think I would expect to be informed if they were identifying the data as mine. Yes, for sure. But not otherwise, if it’s just improving their processes, that wouldn’t bother me. But if they were writing a paper on it and it said patient so-and-so did this, then no. They should either get the consent of the patient or just de-identify it. The issue is of course it’s very hard to de-identify individual cases sometimes.

PCP_02 (74yo, high level of health service interaction)

Ideally/would be nice

In my health record, there is a, like a checkbox saying that your data has been accessed for some reason, and letting a person know. You can say, “Yeah, I want to know something.” That could certainly be made more fine-grained to allow for that sort of thing, especially if that was properly federated and more complete…That principle, I think, could be applied to the records everywhere, whether it was… So if there were more complete records at a hospital or at a GP, the patient could say, “Yeah, look, I’m…” Upfront, “This is what I’m interested in being told about,” so you don’t… “… And then that would solve that problem.

PCP_11 (61yo, high level of health service interaction)

Use for reflective practice

you should probably tell the patients that you’re going to reflect on what happened with them and things like that.

PCP_03 (20yo, high level of health service interaction)

It’s a learning tool for the health practitioner. I get a lot out of it too… The issue for me is around informed consent. Yeah, informed consent, full stop, and most of it being de-identified… I think I would like to see some informed consent around that. I think that would be ideal.

PCP_05 (69yo, high level of health service interaction)

Yeah. I don’t think I need to. I think the qualification I made before is as long as it’s de-identified data for the team.

PCP_06 (60yo, low level of health service interaction

I don’t think that’s something they should be doing without expressed consent. I think once it gets to that level, I mean, again, I think it’s just a general courtesy to let someone know that they were doing that, although now that you said that, they probably already are. It makes sense that they would be.

PCP_07 (63yo, high level of health service interaction)

just letting the patient know that we are having a team meeting where we’re going to discuss your case. If it’s reflecting, I don’t think there’s a need for the patient to necessarily know, unless there’s some learning from the reflection that’s got an immediate application to the patient.

PCP_09 (65yo, moderate level of health service interaction)

I think there still needs to be the caveat of people at that initial point of entry, having the ability to be able to opt in and opt out of that. So, this should be a clear statement. Are you happy to have your information used in this way? And really clear clause statements about how it won’t be used.

PCP_15 (45yo, high level of health service interaction)