Much and all as their antediluvian internet access policy is annoying, if you want to be kept informed about important issues you pretty much have to read the Fin. Today, for instance, there was a report (brief summary here) indicating the difficulties the states and the federal government were having in implementing e-health. Apparently, plans to introduce universal electronic medical records – that is, storing your entire medical history in a centralized electronic database – have been delayed until 2012. 2012? 2009? I wasn’t even aware that a formal plan to introduce such a thing exists, let alone by 2009.
As previously noted here, there are very serious privacy and security concerns about such systems, as well as great potential advantages. If they get it wrong, there’s considerable potential for it to blow up in the government’s face.
So here’s my little question. Before we get to the stage of spending billions – rather than the $150-million odd already spent around the country on such projects – it would be nice if the privacy and security issues were thrashed out. At the very least, it might save a lot of money in redesigns after media pressure forces hasty changes. Are we going to have a public discussion of these issues, or are we going to get another departmental omnibus program that, like the Access Card, is going to be so flawed that the only thing to do once it’s announced to fight is kill it off? Maybe a discussion paper or two to kick things off the discussion, perhaps?
I don’t think that anyone involved in this project truly understands the scale of what they’re proposing. One of the hospitals in this area is looking to digitise their records and the task is massive. It’s not just the sheer amount of data, although that is a significant problem, it’s also the fact that most of the information that is presently in a digital format is in proprietary formats tied to particular application or medical equipment vendors.
Having seen a few hospital IT departments I can say that this is one of the better ones, so if it’s a big challenge for them it will mean even bigger headaches for health services who haven’t got decent IT systems in place.
If this is completed by 2012 I’ll be amazed.
the area health services have been trying to do this for years already and failing dismally, due to cost problems, IT problems and the like. Just merging their community health records with hospital information is a dismal failure, let alone extending it to GPs or digitizing the full record.
The British NHS have managed to get their system for hospital records going quite well (as far as enabling one individual to have a record across the country), and in some cases it can be linked to GP data. The rules on access to and use of the identifying information are hideously strict, and in that regard I don’t think privacy and confidentiality are big issues (occasional major bloopers aside) for most people. But in the UK GPs are much more centrally controlled than in Australia, so it’s unlikely Australia will make progress to anywhere near the same stage.
But this is all just for basic service data – date admitted, diagnoses and operations. Some GP surgeries have more detail (written notes etc.) both in the UK and Australia, but the idea that you can get all that information into a computer is pretty brave. And you would want to make sure that your matching was very good at avoiding false positives, or every time anyone was admitted to hospital they would get a huge list of possible medical histories unless they had a guaranteed failsafe proof of id (e.g. a chip in their head) – even 0.0001% matches amongst 20million people is a list of 20 possible people, 19 of whom will be false positives.
There are also some serious issues I think with things like mental health, substance use and child abuse histories. When a person is being admitted it’s the admissions clerk and nurse who controls their initial treatment, and if they see a flag on the screen which says “ex-prisoner” (this is in the NHS hospital database), “IDU”, “Mental Health problem”, “HIV +ve” etc. this could affect their treatment by those staff. Particularly, the “IDU” tag will follow them all through hospital and prevent them getting pain relief wherever they go. And having a section of the database with a kind of “for your eyes only” seal will only work if the section is completely hidden from those who don’t need to see it, and in my dealings with health IT folk they don’t like that idea, because they seem to think that this kind of flagging of sensitive issues for all to see is a feature, not a bug.
In one place where I worked though we had an excellent system for controlling unruly clients on our in-service medical database. A few simple tick boxes forever got rid of the problem of patients claiming that “so-and-so let me in yesterday” when they were temporarily suspended from service. The same thing could work for hospitals with this kind of system, and enable certain legal flags (e.g. AVOs) to prevent people being admitted. But I don’t see how these flags could be necessary between hospitals, since they tend to represent actions taken within a hospital or clinic, not an area health service.
I also think for the majority of administrators and health IT sorts, these projects aren’t being developed because they are a useful way of storing data, but because the people administering these projects think that by throwing IT at common information problems you can fix them. This is true in some cases (electronic flags indicating a client has an AVO on them are more effective than post-it notes in their medical record, for example) but it is not a priori true in all cases. Linking hospital records to get a medical history doesn’t improve practice if you get the wrong history, big red flags saying “HIV” don’t improve access to health care or patient/staff safety as much as, say, sensitive doctoring and good infection control procedures. I think people need to have a very very clear idea of why they want to do something like this before they throw all this money at it (all health expenditure has a big opportunity cost, after all) and I don’t think they do, mostly.
What, you mean it’s not as easy as just banging up a facebook application, and calling it MyHealthbook, like the 2020Summit boffins and their fellow-travelling
peanutpress gallery would have us believe?You know how the alcopops agenda is sorta driven by the proposition that it’s a damn fine idea to financially couple (drinking) cause with (population health damage) effect?
Well the Fed eHealth folks have taken it to the next logical level: the Brisbane (head?) NEHTA offices are IN a pub, the new Melbourne hotel
mega-development in West End. It’s all very Las Vegas, a pokie palice de-luxe.
Yep, it probably means the government is shovelling Health budget dollars, lots of ‘em, to a gambling and alchohol czar for rent and building services. Or maybe they do a contra deal ( you don’t tax me, I’ll give you space gratis) and cut out legions of middle bean counters. Yeh, right, as if.
I’ll borrow a camera and grab a snap of the melbourne hotel sign with the NEHTA logo directly above the pub’s, and pass it on to Mark.
Considering Health/Sickness in Oz is very much a lottery, maybe they should design a slot machine themed on a public hospital ER visit. One wheel spins to select your health problem, another shows the hospital resources etc –
You have a
infection:cardiac arrest:nasty accidentWe can offer you a
surgeon: IT administrator:radiographerCost to you
medicare card:your house in a reverse mortgage:100 hours community serviceUnfortunate mismatch, you lose, better luck next time, if there is one.
Wanna buy more credits to play again? Remember, every week one lucky Australian wins a completely comprehensive private health cover insurance policy, now with new NoMoreGapFees, but you gotta be in it to win it.
They could call it: BetYourLife
Privacy issues aside (and that’s a big thing to relegate to the corner), as Dave from Albury has alluded to, the system integration issues are possibly insurmountable. It’s not like starting from a clean slate (as happened with integrating ATO and DSS records in the early 1970s), as probably every hospital/medical practice/physio/etc in Australia has its own unique IT system, and no interest in spending the money to build the required interfaces to a national system.
It’s a great pity that the people making the important decisions (here and elsewhere) can be guaranteed to be completely clueless.
2012 is a wildly optimistic delivery date. Insanely madly totally impossibly unlikely.
2018 maybe, if you’re looking at a big-bang rollout.
A better approach would be to establish standards for storage, privacy etc etc and require developers of GP, hospital software etc to conform. Then you keep competition but have some degree of interoperability for portable records and research.
Another place to examine is the USA’s Veteran’s Administration Hospital System, which apparently has the best and most effective IT system in this field.
Robert – totally agree that the security and privacy issues need to be discussed in public. But not in isolation – it does need to be compared to the current situation with paper records – eg a receptionist at a GP can browse through records and there will be no audit trail. So that people clearly understand that downsides to the current situation rather than only seeing the risks of a new system.
Exactly Chris. The potential exists for an integrated digitised system to actually have improved transparency and accountability. Hackers and leakers aside, of course, which will necessarily be the main game.
I’m going to ask my mum about this. As an epidemiologist and very strong believer in confidentiality, it’s a wonder I’ve not done so before.
“Before we get to the stage of spending billions – rather than the $150-million odd already spent around the country on such projects – it would be nice if the privacy and security issues were thrashed out. At the very least, it might save a lot of money in redesigns after media pressure forces hasty changes.”
Hey Robert, why don’t you go to the NEHTA website and search on ‘privacy’ and look at some of the documents. I spent ten minutes and read that they did their first preliminary Privacy Impact Statement in 2006, published a privacy blueprint with a public comment period in 2007, had a “privacy impact assessment” performed by Clayton Utz and are in the first phase of development of an ISO27001 information security framework. The privacy Blueprint received positive comments from the Offoce of the Privacy Commissioner, the Privacy Foundation and the Consumers’ Health Forum.
I’ve got no axe to grind about whether or not NEHTA’s doing a great job, but your assumption that in three years they’ve not done any work on the obvious problems is just wrong.
d
Darryl: fair enough.
But my gut suggests that these proposals usually come out of the bureaucratic meat grinder with privacy issues a mile wide.
See, for instance, the Access Card debacle.
In defence of these people making the decisions (some of whom I have worked with) they aren’t clueless, as David suggests at 4. They in fact know that the system isn’t a blank slate and that they will have to amalgamate a great many different systems, which is why they have spent a lot of time over the past 10 years building minimum data standards (as Jacques suggests) and negotiating to have them implemented in proprietary GP systems like Medical Editor. Of course all the hospitals are already using a standard system all across the world, for comparability of the data at least. And the majority of these systems actually end up working in very similar ways if you use the proper rules of database development.
They do have serious reasons for wanting to do this. As the different chris alluded to, and as I have seen done many times, paper medical records don’t contain a sealed section, and anyone with access to the medical records can check anything they want to know about anyone without leaving any evidence, so we don’t know who has accessed someone’s address, sexual history or HIV status. The IT audit trail is a big plus about the medical record, since it discourages people from looking at things they don’t need to see. That’s how they tried to sell integration to the community health sector in the ’90s, but unfortunately (at least in the areas where I worked) they were a little too dictatorial about how they went about it.
I think the privacy issues can be handled if one is careful. Some suggested ways are:
1. give every patient knowledge about their data rights
2. allow patients to opt out of the integration
3. make basic identifying details the patient’s property, not the doctors (medical records are the doctors property at the moment, I think)
4. have sealed sections to the database which the patient has to authorise anyone else to look at, but which can be broken open in an emergency
5. make sure methods of emergency care don’t depend on a good match with a patients data, since when you aren’t sure who soemone is you may have to breach the privacy of other individuals to find out.
6. somehow convince hospital staff that an opt-out, or having information in the sealed section, doesn’t make the patient a bad person
For the majority of people (those without anything to hide) privacy concerns can be readily addressed by 4. For others, if 4 is handled well it will probably address a lot of their concerns, and for a small number of people 2 will be necessary.
I have an interesting idea with phones too…
one way to solve this problem could be for all GPs, hospitals and community health centres to collect their medical records according to the same standard, but not to be linked. But every individual downloads their medical record to their mobile phone whenever they attend these institutions. Then, when they visit a different doctor the doctor can ask them for their medical records and they can consent or not simply by providing their phone. Further, a set of tick boxes would be all that would be required for each individual to choose what parts of their medical record each doctor would have access to. And obviously in an emergency the A&E staff just take your phone from your cold dead hands, and sign some forms. At the very least this would guarantee the most crucial things – drug interactions and allergies – were available at emergency centres.
But the phone could have other uses too… your doctor could download care plans or pharmaceutical rules onto it, so the phone reminds you to do stuff with alarms, or you can check your drug against your calendar. Middle-aged men could have drinking guidelines on their phone and enter the drinks they have bought, so the phone can tell them when ina week they are past their healthy limit. The government could even offer tax rebates on mobile phone plans for people who subscribe to particular plans – particularly, for example, women who subscribe to well woman reminders (pap smears and breast screening) might get a small rebate. Or (and I love this) the govt offers a rebate for anyone who allows their basic health data to be uploaded from the phone to a govt system, deidentified, every month or year. So we can genuinely track health without having to ask the hospitals.
This obviously protects your privacy because no-one has your medical record without you being asked. It enables you to confirm that your basic details are correct without having to be sick, to control the level of access individual clinicians have, to keep all your health records in one place, and to protect you from stupid mistakes (”what antibiotic am I allergic to again? I think it’s written on a slip of paper in my back drawer…”). It uses IT to improve health management and continuity of care, and offers an obvious way to “empower patients”, which is such a buzzword these days.
The only problem of course is that you don’t own your own medical record, so all the notes GPs write would have tobe encrypted against your reading them…
“they aren’t clueless, as David suggests at 4. They in fact know that the system isn’t a blank slate and that they will have to amalgamate a great many different systems”
A senior technical person in NEHTA (not in the privacy/security area) told me recently that the biggest headaches by far are not the technical problems of data integration (which are fiddly and tedious, but well-understood and straightforward) but the politics that comes with it. The existing E-health market is immature and there’s an enormous array of ‘niche’ vendors each of whom has their own little patch of turf to defend (either functionally or geographically or within a medical specialisation) and are lobbying directly and through proxies/agents/champions.
Consider the sort of impassioned lobbying one gets from Mac (or Linux) zealots on a bad day. Now imagine there’s 30 different platforms. And these are medical apps and the advocates are Doctors who are largely uninterested in Information Systems.
Data integration is the least of NEHTA’s problems.
d
Use a little lateral ( or contrarian) thinking and you get centralized bad – distributed good.
State control bad – user control good.
Proprietary control bad – open source good.
And so if you want the latter day STASI pawing through yr health records and sending copies off to Admiral Poindexter’s Totalitarian Information Agency in Singapore then say no more.
If you want user control through encryption, remailers and translucent Sql databanks instead of Golden Shield, TIA, CIA, Oracle, CISCO, MS, STASI central command and control then jack up now. Arc up against the FBI, AFP, Etc, etc, etc.
This is when we either tell them where to step off or make up our face for the imprint of the boot forever.
Please don’t put this one in the ‘too hard’ basket. Just a few short years ago the net was basically pwned by the lunar right in the USA. No longer…since 2005 we are winning. Privacy and security are key – its people power or the nightmare.
Is it technically difficult? I already trust the systems used by banks/credit card companies/Paypal to keep my financial details private. How hard would it be to get GPs, specialists, pharmacists, pathology labs, X-ray services, nursing homes and hospitals sharing health records?
I bet the problem is in getting the states to agree and navigating the turf wars and vested interests within medicine.
No doubt Nicola Roxon has appointed a committee to look into all this and to report back in 2012. In the meantime your GP retires and your medical records go into the wheelie bin.
Doesn’t that come back to Jacques’ point about standards for storage, privacy and interoperability? If you do that rather than try to pick a specific vendor, not only do you avoid vendor lock-in with associated higher costs, but you allow for a more gradual tested roll-out as well as a lot more transparency. And people can run on whatever platforms they want (making all GPs run windows for example seems a rather unnecessarily silly thing to do).
Chris, this is exactly what they have done and are doing. Every hospital runs its own hospital data collection system, for example, but you can compare hospital events pretty seamlessly between the US, UK and Oz because they use the same standard. Due to the wonders of a certain type of algebra there is really only one way to efficiently store records on peoples’ attendance at a hospital, all you really need to do is come up with a standard for the exchange of data and a standard for the collection of information on diagnoses and procedures. And most software vendors are more than happy to build this sort of stuff into their systems because extensibility is the key to business growth when you are in data management. If the government (or for the libertarians among us, a large network of private hospitals) wants to use a particular standard of data exchange, and is willing to fund hospitals to use that standard, most private vendors are going to be falling over themselves to do it. This is why every reasonable vendor of hospital information systems in the developed world uses the ICD standard.
And the “gradual tested roll-out” is what the health services have been doing over the last 10 years, though in many cases very badly.
michael_w, the technical difficulties really boil down to just 2 things: storing huge amounts of information on everyone in a way that can be usable and meaningful while protecting privacy across a variety of different institutions; and ensuring that when you turn up to the hospital or clinic you can guarantee that the staff will get the right identity for you, even if they’re harrassed and rushed, and even though you have records scattered across 16 different institutions and may have made multiple copies of yourself during your history of stupid interactions with health services. But here’s a hint: the staff at the Medically Supervised Injecting Centre can do this when dealing with drug-addled IDUs who are desperate to get into the next stage of the process, and the staff can identify the individual while they are assessing his or her suitability for admission. So it can be done.
Having resolved the technical difficulties you need to ask – is it worth it? What are the putative benefits of a single medical record? The audit trail mentioned above doesn’t require a single unified system to work, after all, every database on individuals should have such a system in the modern world. The putative reason for the combined medical record is continuity of care, and I really can’t see that it will make a huge difference to this issue.
Robert – totally agree with your skepticism.
But let’s think for a moment – many of the basic structures required to give reasonable privacy and safe data storage for health records give massive benefits to ANY information management initiative by government.
I just wish that dependency component trees across a wide range of initiatives were written down properly, and the common elements all others require were implemented first.
A whole-of-government reliable single-sign-on and role-based privileges setup would be one of the first cabs off the rank as far as I see it. It’s just one of the “necessary but not sufficient” components we need. (OK, you can make a list of all the spin-off benefits…. it’s a huge list)
Unfortunately, the pollies, the press, and the general public cannot see it.
If Rudd and co say they want to improve infrastructure, then they should realize that infrastructure isn’t limited to energy, water, and transport of goods and people – there is information infrastructure as well. Without such a perspective, everything is doomed.
Information infrastructure is impossible to turn a sod for, or to lay a foundation stone in front of cameras.
But information is more and more becoming the primary product of government by volume. It can’t be half-arsed.
I would have thought the continuity of care issue was paramount, just to be different. The major issue with the medical record is it’s unavailability. Even if you hit the door of your usual public hospital it is at least ten minutes until your history joins you, more usually an hour or two. If you have something urgent that is long enough to make a long and spectacular series of mistakes. If the person involved is at a different hospital or usually seen in someone’s private practice then their records will join them at some unspecified future time. Maybe.
This is further compounded in outpatient practice where previous opinions and treatments may not even be known to exist, let alone detailed. I personally say much fewer stupid things to people when I have their records in front of me.
In terms of the content, I also feel a great level of detail will be required to make it at all worthwhile. I really can think of little benefit in knowing someone’s hospital discharge codes. I want the notes of the person who saw them in their possibly unreadable entirety.
A diagnosis without providence is merely noise.
Jacques – I think we need some creativity here, along the lines of sod-turning, ribbon-cutting etc…
Howsabout a novelty-sized ENTER key?
Thanks everyone, for commenting.
Dr S: Interesting point about the level of history detail you want for a diagnosis. In an ER situation, would a simple system where critical stuff – “this patient has a pacemaker”, “this patient has Crohn’s disease and is taking Immuran”, and so on, achieve a lot in terms of patient safety, without requiring every x-ray, pathology report and whatnot to have a common format?
I’d just like to discuss the time scales and consent issues a bit more. I appreciate that in an ER you want the patient’s entire medical history, and you want it now, and the patient, or even an appropriate representative, doesn’t have time to consent.
But that’s an exceptional situation. Most of the time, there’s time for consent to be arranged; furthermore, does your orthopedic surgeon really need to see that you were treated for depression 20 years ago?
I’m just concerned that a scheme where there’s a “there is a secret section in this medical record” flag for every nurse, physio, and assorted specialist to see is going to tempt every health professional involved in treating the patient to try and find out what that secret bit is.
Robert – Those kinds of things are helpful, particularly a medication list, but the more detail the better. As to the time scale, this was not about consent. That conversation usually takes about 15 seconds (Q:Do you mind if I call your doctor about that and get all the previous tests and letters and things? A:No problem.). The issue was availability in a clinically relevant time scale. I often get outpatient stuff the week after I saw the patient and have to drag them back to change the diagnosis. Also, if the detail is insufficient, a parallel hard-copy record is also needed, removing one of the main advantages of digitization.
As to the consent, one uncommonly sees people who wish to hide their medical details from their doctor and it is not a good start. From a privacy point of view, yes it seems unnecessary for your orthopaedic surgeon to know you were once depressed. The problem is that the kinds of details people try to suppress usually are the ones most needed, rather than the embarrassing trivialities.
For instance, the HIV positive tag mentioned above. As to infection control, this is a minor issue. The major issue is the disease itself. Fever and a CD4 count of 76 is a much more serious issue than fever alone. Similarly, the range of illnesses seen in HIV are radically different at all stages of the disease. Most people living with HIV know this very well and are upfront about the diagnosis, mainly because it saves them being mucked around with the wrong advice and wrong tests.
The things people most try to hide in my experience is previous diagnosis of hysterical illness. A tactic that usually wastes time but rarely leads to harm. As to wishing to hide other details, even psychiatric and drug use things, that does not appear common to me.
Oh, and most ED physicians agree opiate users need more, rather than less, analgesia.
Dr S, when I mentioned continuity of care I wasn’t thinking so much of A&E as I was chronic disease management, where the urgency isn’t there and the importance of being a good doctor who is trained and able to engage in some kind of care process – rather than merely being an informed doctor – seems more relevant. I’m sure there are lots of doctors (especially GPs, at a guess) who poo-poo the opinions of allied health professionals and don’t care so much for what they see as woo-y notions of multidisciplinary care, etc. Giving these doctors a complete history may not make that much of a difference. I think we both know that chronic disease continuity of care has a lot of shortcomings now, and those shortcomings have to be at least partly due to the training and attitude of doctors and nurses. I wonder how much this could be improved if we spent this IT money on proper training and support for those processes – after all it is in chronic disease management that Australia’s future health challenges mostly lie, not improving A&E performance.
As for your point about seeing the entire notes, if calling up the whole lot could prove too onerous a compromise system could be easily developed where A&E staff work out a system of flags which all GPs can edit, and which turn up as warnings when someone enters A&E, so that you don’t need to see all the notes to get an immediate warning of any risks for the patient. There are probably a lot of elements of a good history which can improve a diagnosis, but in an urgent admission there may be more limited information which can be sufficient to protect the patient. It’s not perfect but it would be an improvement, I would think, on at least the risk of making serious mistakes in emergencies. Again though, I doubt this represents a significant portion of Australia’s preventable death rate, and the money could probably be better spent on gym memberships for fat people (or something).
I agree with you about HIV and the behaviour of patients with HIV in the broad, but I don’t agree with you about IDUs and analgesia. It’s well-established that opiate users have routinely bad experiences in hospital due to pain relief problems, and more broadly that they are seriously discriminated against by hospital staff at all levels. (Of course, many IDUs are pretty obviously IDUs no matter what their medical record says). I do agree that this discrimination is slowly disappearing, as it mostly has for patients with HIV, and this does make these systems easier to implement now than they used to be. In the community health sector we were very familiar with what happened to our clients in hospital and there were a whole range of things we didn’t think the Hospital system was very, ah, qualified to know for no reason.
Robert, the sealed section does act as a tip-off for staff to have a peek. This is a bad thing. The good thing though is that you can see who did it, and have a word with them about how medical records aren’t just interesting reading material. So in the long term it could provide a good lever for getting medical staff to realise that information is not just their privilege but actually in some sense belongs to the patient.
Dr S also gives the lie to Daryl’s assertion that “these are medical apps and the advocates are Doctors who are largely uninterested in Information Systems.” In my experience, Doctors and nurses are very interested in any IT tool which will improve their ability to provide a good service. But like all IT users they want the machine to make work easier, not harder, and like everyone else they are often not willing to believe that your average IT nerd could deliver such a combination of benefits.
‘Dr S also gives the lie to Daryl’s assertion that “these are medical apps and the advocates are Doctors who are largely uninterested in Information Systems.”’
you’ve over-generalised my comment and seem to have misunderstood what I meant by Information Systems. I apologise for being unclear.
There exist doctors who are vocal advocates for particular vendors and their advocacy may be around specific functionality offered by the vendors tools or legacy support or migration issues or what have you. These particular doctors are highly interested and enthusiastic about the ‘IT tools’ they use and their potential, but they are not actually interested in or well-informed about the design of huge, distributed information systems with privacy and security and standards compliance and all the other stuff being worked on.
Nothing wrong with any of that, it kind of goes with the territory, but the diversity of vendors in the market and the privileged position of doctors in medical matters means progress is a lot slower than you would find in similar projects. (Eg, you wouldn’t expect a process for, say, Universal Education Records and Identifiers to grind to a halt until the every concern of Hospitality lecturers and Home Ec teachers had been addressed)
(And at the risk of beating a dead horse, how about reading some of Nehta’s papers about the system before fretting about ’sealed sections’ and the risk of professional clinicians succumbing to curiosity about the 324th set of records they’ve had to look at today)
d
Dr S, Ive been told by a nurse that if a patient discloses drug use in a hospital, they get a big “D” written on their file. Ever come across that?
d
Darryl – Nope but you certainly get IVDU written as part of your past history, this being of relevance and significance to a number of things. There is no doubt there is a level of prejudice against those with significant drug habits but there are also substantial problems that crop up fairly frequently. This is also not helped by the fact that giving someone a drug they enjoy can cost one’s registration.
As to one’s privileged position, it is no more than any other end user. Tbhe point I made above is that a bare-bones data system is not a medical record, it is an administrative record of medical attendence and care. You cannot replace the paper record with anything of less thorough detail without damaging care. The analogy for University is not education records but rather an on-line system for all teaching materials. A situation where the lecturers would be directly involved.
If all that is happening is a central system for the administration of episodes of care and a basic algebra of disease then this has no relevance to my practice at all. If you want a truly centralised record, that is a different story.
“As to one’s privileged position, it is no more than any other end user… The analogy for University is not education records but rather an on-line system for all teaching materials. A situation where the lecturers would be directly involved.”
Heh. It would be imprudent for me to say much about how “Learning Management Systems” have been introduced into Universities, but suffice to say that the sentence “Well, you’ll just have to change how you teach” would be very familiar to academic staff who’ve been through the introduction process (Except, of course, for lecturers in Medicine) :^)
d
Dr S I think you’re right, as soon as you introduce a compromise on completeness of record to such a system – in the interests of saving space and time and network bandwidth – the system will probably lose its utility for aiding diagnosis and management. So then you are left developing a still-very-expensive data network for the purpose purely of aiding that tiny proportion of medical events that happen in emergency rooms where the patient can’t communicate or doesn’t know the answer to your questions (the kind of subset of tick boxes I mentioned above). I doubt that is an effective use of government funds compared with all the other health expenditures they could be used for.
Further I think if one could develop a fairly effective complete national medical record for everyone, which was good enough to improve continuity of care and chronic disease management through improved history taking (which is the only benefit an integrated national system offers over and above non-integrated local ones), the cost of doing so, and of running it, would also not justify the benefits it would bring. I doubt that there are many GPs or hospital doctors out there who are so confident in their skills that they would turn down the kind of immediate capital and training investment, and ongoing support for improved quality care, which this kind of money could buy for our system. An obvious use for this money would be to buy every GP surgery an existing off-the-shelf medical records system of their choice and provide them with the computers and training to use it, so that all doctors got immediate access to the efficiency benefits it provides them.
I suspect this IT investment plan is the health version of computers in schools – it looks good on paper, but 0 evidence that it makes any difference to the outcomes we are seeking, and the most expensive way to get any outcomes that do emerge.