Distributed security, Re: Master Patient Index systems and Public Health
On Tue, 16 Dec 2003, [EMAIL PROTECTED] wrote: ... After so many cases of abuse of power from around the world, credibility will be quite difficult to achieve. Any guarantee is only going to be as good as its perceived strength. How do you propose to backup such guarantees? ... Information archiving, retrieval and update cannot be completed without the Patients active participation. The Payer and Provider can each hold a key that individually and together cannot create access to the information and join the constituent parts. Sounds very interesting. What do you mean by active participation? Does the patient hold/present a key too? It is not the traditional all-in-one information storage. How does it work? The number of keys can be variable. Unless you convince the Patient and their support groups to participate the records are neither accessible nor complete. What if the patient loses his/her key? Best regards, Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org
free healthcare software and economic model, was Re: models and things
On Thu, 18 Dec 2003, Adrian Midgley wrote: ... How does one build Open Source healthcare software so as to stay out of hot water in a variety of economic models? Adrian, If I may, I believe the question you posed is utterly non-sense. Economic models attempt to describe real-world occurances, observations, transactions, behaviors. Open source software are real-world objects that are produced, traded, and used. Thus, however one goes about producing software, these real-world behaviors just cannot get into hot water relative to any economic model. One the other hand, certain economic models may not adequately describe/explain/predict certain real-world occurances. Then, maybe a new model is needed. If I misunderstood your question, please feel free to clarify. Best regards, Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org
Re: Distributed security, Re: Master Patient Index systems and Public Health
Hi Andrew, Comments in text. Regards! -Thomas Clark Andrew Ho wrote: On Tue, 16 Dec 2003, [EMAIL PROTECTED] wrote: ... After so many cases of abuse of power from around the world, credibility will be quite difficult to achieve. Any guarantee is only going to be as good as its perceived strength. How do you propose to backup such guarantees? ... Information archiving, retrieval and update cannot be completed without the Patients active participation. The Payer and Provider can each hold a key that individually and together cannot create access to the information and join the constituent parts. Sounds very interesting. What do you mean by active participation? Does the patient hold/present a key too? The Patient or the Patient's representative holds a key. The representative can be a legal representative, a family member or a private security agent. Both the Patient and the representative should have a tool to audit requests for access. The key is in turn limited/restricted, i.e., you can access records related to a specific condition my not other non-related conditions. It would also be in part declarative, e.g., the Patient can withhold permission to use their DNA. The Patient's key would have a structure compatible with their records hence their would be a Patient-specific format that supported general information, e.g., date-of-birth. It works with a structure that makes records objects. It is not the traditional all-in-one information storage. How does it work? The number of keys can be variable. Unless you convince the Patient and their support groups to participate the records are neither accessible nor complete. What if the patient loses his/her key? Patient keys can be re-generated from Records-based information (similar to fault-recoverable file systems). Since the key is not saddled with a fixed format, additions and modifications will modify the key. The Patient provides information and updates rules. The physical format of a key is simple. 256 MBytes in the volume occupied by a 25 cent coin leaves some room for other things. You might inject it like my dog's ID, but I'll opt for the alternative. BTW: This also supports record-tracking. Best regards, Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org
Re: free healthcare software and economic model, was Re: models and things
Andrew Ho [EMAIL PROTECTED] wrote: On Thu, 18 Dec 2003, Adrian Midgley wrote: ... How does one build Open Source healthcare software so as to stay out of hot water in a variety of economic models? Adrian, If I may, I believe the question you posed is utterly non-sense. Impeccably well mannered. Economic models attempt to describe real-world occurances, observations, transactions, behaviors. Open source software are real-world objects that are produced, traded, and used. Thus, however one goes about producing software, these real-world behaviors just cannot get into hot water relative to any economic model. One the other hand, certain economic models may not adequately describe/explain/predict certain real-world occurances. Then, maybe a new model is needed. If I misunderstood your question, please feel free to clarify. If I may answer in Adrian's stead for the time being... Yes, you misunderstood the question. Adrian was referring to the fact that in order to be useful, health software (open source or not) needs to model or reflect the social and economic milieu in which it is used, and these environments differ from country to country. His question was how to generalise software so that it suits a number of settings, from the mostly private-sector healthcare system in the US, to the primarily state-run health systems in many European countries, and many shades in between. A very sensible question, without a simple answer, I fear. He was not asking about how to trade in open source software as goods (or services). Tim C
simple medical/social data collection question
Last night I went for a walk with two friends. One used to work at an abuse center that wants to computerize standard data collection which is now just paper forms. This would also entail centralized collection of reportable data, etc. The other works as a the head nurse in a hospital section (stomache stapling) where there was no tracking of return visits due to complications. For the time being she's setup, on her own initiative, a simple spreadsheet program to get those stats but ultimately may want to move to something more flexible than a spreadsheet program. Note that these are very simple apps from the perspective of the potential users. They don't want a full EMR database. On the other hand I don't believe the potential users have thought through security/privacy issues, patient ids, etc. In other words all of the stuff that comes up after the first cut into the app. In either case there is very limited funds for development. I'd like to do some homework re the systems worked on by individuals on this list to get a sense of how much time would be required to setup these systems. So, current recommendations? I know this is an awkward question because I am so nebulous in my spec. I apologize. Don't waste a lot of time answering my question, just a few pointers and fast comments would be appreciated. Thanks, Heitzso
Re: Master Patient Index systems and Public Health
Karsten Hilbert wrote: opinion of those 60% who do not vote in US elections is unknown, And how exactly is this any bad ? Maybe they don't want the government to know ? Aah, but if the premise of the government is representational of the people, then by not wanting any representation, these people are saying they don't want the form of government in place. I would have to say that if you want to interpret that 60% of any population does not wish the present form of government, things, indeed are very bad. But, I don't think that is the interpretation in the US of lack of participation. Rather the interpretation is ennui. -- Wayne Wilson An attachment containing my pgp-signature is included. My public key fingerprint is: 9325 05AD 866B BCCB 45BF E86A 63E1 C6ED 4130 5461 My public key can be downloaded from wwwkeys.us.pgp.net pgp0.pgp Description: PGP signature
Vista on the BBC News Web-site
http://news.bbc.co.uk/1/hi/technology/3331739.stm Regards George George James Software 42-44 High Street Shepperton Middlesex TW17 9 AU United Kingdom Tools, Training, Technology www.georgejames.com +44-1932-252568
Re: Vista on the BBC News Web-site
http://news.bbc.co.uk/1/hi/technology/3331739.stm Interesting. But this is very old software and maybe unsuitable for the purpose. Open source software has gone very far indeed since the days of VistA. It will eventually cost the poorer countries to go in for obsolete software. Nandalal Nandalal Gunaratne Urological Surgeon Colombo South Teaching Hospital Sri Lanka -- __ Check out the latest SMS services @ http://www.linuxmail.org This allows you to send and receive SMS through your mailbox. Powered by Outblaze
Re: Vista on the BBC News Web-site
Nandalal, No offence intended...your point is very old too and has been made by many in health informatics for many years now. In the mean time VistA continued to evolve and for some time now we have had OpenVista too. There is far more to an application than the underlying nuts and bolts...which I might add work very efficiently and very well in VistA. Certainly it can be improved and the whole point of open source IMHO is to work and improve on the valuable contributions that have already been made. In VistA's case there is a tremendous amount of value and effort on the part of the US VA that can be built upon. As for the economic argument...one has to consider the total opportunity cost to societies and health systems of waiting for the ideal system to come along...does one start with something proven and works today and evolve from there or start with a clean sheet and reinvent the wheel. I am sure that both strategies will prevail. Cheers, Joseph On Fri, 2003-12-19 at 10:27, Nandalal Gunaratne wrote: http://news.bbc.co.uk/1/hi/technology/3331739.stm Interesting. But this is very old software and maybe unsuitable for the purpose. Open source software has gone very far indeed since the days of VistA. It will eventually cost the poorer countries to go in for obsolete software. Nandalal Nandalal Gunaratne Urological Surgeon Colombo South Teaching Hospital Sri Lanka
RE: Vista on the BBC News Web-site
As one of VistA's users, I'll submit that while it has older origins, it is continually being updated and is still our (US Dept of Veterans Affairs) main system. It still works extremely well, and even includes interfacing software for image capture and management from new technologies. I trust my own health care to it. And since it's open source, it is VERY user maintainable. As an aside, the medical equipment management program, while text based, still is better than any commercial package I've seen. Paul Sherman Biomedical Engineer VA Center for Engineering Occupational Safety and Health (CEOSH) St. Louis, MO [EMAIL PROTECTED] -Original Message- From: Nandalal Gunaratne [SMTP:[EMAIL PROTECTED] Subject: Re: Vista on the BBC News Web-site http://news.bbc.co.uk/1/hi/technology/3331739.stm Interesting. But this is very old software and maybe unsuitable for the purpose. Open source software has gone very far indeed since the days of VistA. It will eventually cost the poorer countries to go in for obsolete software.
Re: Distributed security, Re: Master Patient Index systems and Public Health
Quoting [EMAIL PROTECTED] [EMAIL PROTECTED]: ... Information archiving, retrieval and update cannot be completed without the Patients active participation. The Payer and Provider can each hold a key that individually and together cannot create access to the information and join the constituent parts. Sounds very interesting. What do you mean by active participation? Does the patient hold/present a key too? The Patient or the Patient's representative holds a key. The representative can be a legal representative, a family member or a private security agent. Both the Patient and the representative should have a tool to audit requests for access. The key is in turn limited/restricted, i.e., you can access records related to a specific condition my not other non-related conditions. It would also be in part declarative, e.g., the Patient can withhold permission to use their DNA. The Patient's key would have a structure compatible with their records hence their would be a Patient-specific format that supported general information, e.g., date-of-birth. This sounds good and very useful. Typically in a key-based system, the most difficult part is key management - from the moment of key creation. In your design, who creates these keys and how does the system assure the security of that process? ... What if the patient loses his/her key? Patient keys can be re-generated from Records-based information (similar to fault-recoverable file systems). What prevents non-Patients (e.g. evil government agents) from re-generating patient keys? Since the key is not saddled with a fixed format, additions and modifications will modify the key. Do you mean changing information in patient records always lead to a modified key? The Patient provides information and updates rules. That sounds good. The physical format of a key is simple. 256 MBytes in the volume occupied by a 25 cent coin leaves some room for other things. You might inject it like my dog's ID, I agree. We can store keys on portable devices. However, there may still be unresolved issues relating to key-regeneration and key-updating. Best regards, Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org
RE: hand drawn diagrams stored in a medical record app?
Two pieces of software spring to mind: Adobe Acrobat Create a base form that is your picture of the Man and Woman and The use either the free form comment tool or the text box tool to Annotate the injuries Microsoft Visio In Visio you would create a custom template of injuries that Could be dragged and dropped onto the male or female figure. Some customization of the app would be required in both cases but no programming. -Original Message- From: Heitzso [mailto:[EMAIL PROTECTED] Sent: Friday, December 19, 2003 7:41 AM To: [EMAIL PROTECTED] Subject: hand drawn diagrams stored in a medical record app? I saw the current domestic violence forms that would need to be entered into some form of a database and there are two simple pictures on the form of a man and a woman. On these pictures the reporter is supposed to hand draw in the various injuries. ?? Is there any software (open source or otherwise) that can be easily setup to handle this? Thanks, Heitzso
Re: Master Patient Index systems and Public Health
Aah, but if the premise of the government is representational of the people, then by not wanting any representation, these people are saying they don't want the form of government in place. True. Also, one doesn't care about what the premise of a government is but rather what it actually is. I would have to say that if you want to interpret that 60% of any population does not wish the present form of government, things, indeed are very bad. True, and why not, maybe ? But, I don't think that is the interpretation in the US of lack of participation. Rather the interpretation is ennui. And so what ? How is *that* any bad ? There's always the question why there's widespread ennui. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Re: Master Patient Index systems and Public Health
-- Albrecht Marignoni orthoPoint Network http://www.orthopoint.net - Original Message - From: Karsten Hilbert [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Friday, December 19, 2003 6:59 PM Subject: Re: Master Patient Index systems and Public Health Aah, but if the premise of the government is representational of the people, then by not wanting any representation, these people are saying they don't want the form of government in place. True. Also, one doesn't care about what the premise of a government is but rather what it actually is. I would have to say that if you want to interpret that 60% of any population does not wish the present form of government, things, indeed are very bad. True, and why not, maybe ? But, I don't think that is the interpretation in the US of lack of participation. Rather the interpretation is ennui. And so what ? How is *that* any bad ? There's always the question why there's widespread ennui. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Re: Distributed security, Re: Master Patient Index systems and Public Health
Hi Andrew, Comments in text. Regards! -Thomas Clark HO,ANDREW wrote: Quoting [EMAIL PROTECTED] [EMAIL PROTECTED]: ... Information archiving, retrieval and update cannot be completed without the Patients active participation. The Payer and Provider can each hold a key that individually and together cannot create access to the information and join the constituent parts. Sounds very interesting. What do you mean by active participation? Does the patient hold/present a key too? The Patient or the Patient's representative holds a key. The representative can be a legal representative, a family member or a private security agent. Both the Patient and the representative should have a tool to audit requests for access. The key is in turn limited/restricted, i.e., you can access records related to a specific condition my not other non-related conditions. It would also be in part declarative, e.g., the Patient can withhold permission to use their DNA. The Patient's key would have a structure compatible with their records hence their would be a Patient-specific format that supported general information, e.g., date-of-birth. This sounds good and very useful. Typically in a key-based system, the most difficult part is key management - from the moment of key creation. In your design, who creates these keys and how does the system assure the security of that process? ... The keys CAN be generated automatically however it is interesting that the Patient could supply additional personal information that would be included, e.g., some information from their past that would be difficult to obtain otherwise, such as the color of their first automobile. The repository of the Patient's records, assuming archival functions, could generate keys for the Patient on a periodic basis and where new records are received. Important is the ability to update the key the Patient carries. It would still remain 'active' until the Patient updated their key. What if the patient loses his/her key? Patient keys can be re-generated from Records-based information (similar to fault-recoverable file systems). What prevents non-Patients (e.g. evil government agents) from re-generating patient keys? To regenerate the keys non-Patients would have to have access to the records, and key-generating algorithms that use them, the Patient's personal information, the current key, and the Patient. The repository can be placed outside the jurisdiction, e.g., in multiple, dispersed, redundant, cooperating jurisdictions, e.g., Bermuda. Since the key is not saddled with a fixed format, additions and modifications will modify the key. Do you mean changing information in patient records always lead to a modified key? Yes. A quick way of determining that the records base has changed is required. This should initiate other supporting activities. An underlying presumption/requirement is that the records base is redundant. How redundant is an issue but for sure one would not want to lose this information (Kaiser should be listening). New records translate into change. Access using an old key provides an opportunity to look closer at the requestor. Notification to the Patient may be proper. What response the Patient desires may be pre-loaded. The Patient provides information and updates rules. That sounds good. The physical format of a key is simple. 256 MBytes in the volume occupied by a 25 cent coin leaves some room for other things. You might inject it like my dog's ID, I agree. We can store keys on portable devices. However, there may still be unresolved issues relating to key-regeneration and key-updating. There are many other unresolved issues that touch areas that affect the Patients and support groups but are well beyond the scope here. Appreciate your interest.! Best regards, Andrew --- Andrew P. Ho, M.D. OIO: Open Infrastructure for Outcomes www.TxOutcome.Org
Re: hand drawn diagrams stored in a medical record app?
This is not a simple question, it depends on whether you want to draw such pictures on the computer screen, or scan them in once they have been drawn... In either case, there are two software projects that would be appropriate for an abuse facility (pretty vague description). You should start there and then contribute or fund the body diagraming... Look at FreeMED-Yirc http://freemed-yirc.familyandyouth.org/ and SQLClinic http://www.sqlclinic.net/ both of which support mental health EMR data specically, they would have the underlying infrastructure to do what you want. I dont know about any paper dolling system integrated into a FOSS project yet... Though it seems like a good idea. -FT On Fri, 2003-12-19 at 09:41, Heitzso wrote: I saw the current domestic violence forms that would need to be entered into some form of a database and there are two simple pictures on the form of a man and a woman. On these pictures the reporter is supposed to hand draw in the various injuries. ?? Is there any software (open source or otherwise) that can be easily setup to handle this? Thanks, Heitzso -- Fred Trotter [EMAIL PROTECTED] SynSeer signature.asc Description: This is a digitally signed message part
Re: simple medical/social data collection question
Note that these are very simple apps from the perspective of the potential users. In either case there is very limited funds for development. So, current recommendations? In all fairness that sounds like a scenario where OIO might actually be suitable. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Re: hand drawn diagrams stored in a medical record app?
I've been looking through my EHR/EMR bookmarked URLs and noticed that TORCH allows someone to upload a JPG. This isn't the same as marking up a simple diagram with mouse movements, but is an interesting variation. I appreciate everyone's comments on this (and the broader data collection) problem. Heitzso
RE: hand drawn diagrams stored in a medical record app?
A Tablet PC would be a great interface device. Developing a database to store the images and link to a Patient Record ID would be trivial. If that is the only purpose of the database. Aloha, Steven B. Tomlinson [EMAIL PROTECTED] Pacific Telehealth and Technology Hui www.PacificHui.org -Original Message- From: Heitzso [mailto:[EMAIL PROTECTED] Sent: Friday, December 19, 2003 5:41 AM To: [EMAIL PROTECTED] Subject: hand drawn diagrams stored in a medical record app? I saw the current domestic violence forms that would need to be entered into some form of a database and there are two simple pictures on the form of a man and a woman. On these pictures the reporter is supposed to hand draw in the various injuries. ?? Is there any software (open source or otherwise) that can be easily setup to handle this? Thanks, Heitzso Tomlinson, Steven B.vcf Description: Binary data
