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It is the first working Monday of the month and Dr K Track has just reached the surgery to begin work for the week. Before seeing his first patient he goes over to his printer where he picks up the letters which have been automatically generated by his computer system on Sunday night. [A] These letters are the reminder letters for all his patients who need to attend the practice in the next month for either disease surveillance, screening or immunisation. He checks and signs each of the letters (approves e-mail reminders for those patients who have requested this service) notes that and then asks his office manager to put the remaining letters in the mail. [B]

Two days later Mrs Jones rings the surgery to obtain an appointment for her bi-annual Pap Smear and to bring her young daughter along for her measles vaccination. (The computer had noted the daughters need for the vaccination during that month and offered each an opportunity to come with the other if they wished, with back to back appointments). [C] As it happened Mrs Jones’s daughter was happy to come along with mum and they arrived together a few minutes before their appointment time. After checking in with the receptionist they were informed that there were two people ahead of them in the queue to see Dr Track and asked would they like to have a quick cup of coffee while waiting. The ladies had agreed Mrs Jones would see the doctor first and so, when their turn came Mrs Jones went in first.

Dr Track immediately opened her clinical record on his system and was reminded that eight years ago Mrs Jones had had a life-threatening episode of asthma and that her asthma status should always be reviewed when she was seen for other reasons. An immediate peak flow measurement was taken using a small peak flow meter connected to Dr Tracks computer, and the results were, after review, and confirmation by her that her asthma control appeared excellent, was filed in the Electronic Health Record. [D]

Dr Track then, after inquiring were there any other matters Mrs Jones wanted to raise, and recording the reason for this encounter to be routine screening, has his nurse join them while the smear was taken. Just prior to taking the smear the accompanying request forms had been automatically generated for the specialist cytologist Dr Track refers to, as well as a sticky printed label to attach to the specimen container. [E] Having confirmed there were no other preventive or screening activities due, Dr Track quickly printed a repeat prescription for the inhaled steroid Mrs Jones was on regularly. [F] Dr Track then closed her record and printed an invoice and statement for the services provided.

Ms Jones then joined Dr Track, being happy to have mum present for moral support while having the needle. Dr Track confirmed Ms Jones was well, was doing fine at school, and required no other service other than the measles vaccination. [H] A quick change of screen to the inventory system for the practice showed that the stock held was just above the automatic re-order level and that the batch has a year to run prior to expiry.[I] Dr Track took one ampoule from the stock and recorded it as having been given to Ms Jones, along with the date and time of the immunisation and the vaccine batch number. [J] He then gave the vaccine, waited to ensure Ms Jones had no acute reaction, created an invoice for the service. [K] Dr Track then closed Ms Jones’s record and showed both ladies back to the receptionist where the billing arrangements were finalised.

Two weeks later Dr Track ran his outstanding diagnostic test report for the end of the month, [L] and noted, among other things that he had yet to see the report for Ms Jones’s smear. He decides to give the laboratory a further week for the result to arrive and makes an electronic note to ensure he remembers to check in a weeks time if the result has not arrived in the meantime. [M]

At the end of the month Dr Track runs his pre-prepared reports for the Commonwealth Government and Medicare to claim payments for his vaccination and cancer screening activities during the month. [N]

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