Hi David,
Have a close look at the Shared EHR report from NEHTA - not more than a month or two old. The main architectural diagram still has large repositories (bottom right). I see it as a much less distributed approach than Toms's - to say the least.
I must say I am a strong supporter of incremental approaches to achieving inter-operation and the various (open source and proprietary) approaches all have something to offer - as does the work done in the EHR Vendors Association Roadmap that was released a week or so ago (based on IHE based approaches) (Google EHRVA Roadmap to find it). The reason I support the incremental is simply that the big repository based approaches all seem to develop levels of complexity and user resistance that either dooms them or slows them awfully.
We need to make headway faster than that - and NEHTA should be leading that thrust - may be at the Vendor briefings at the end of the month we will see some clarity.
Cheers
David
---- Dr David G More MB, PhD, FACHI Phone +61-2-9438-2851 Fax +61-2-9906-7038 Skype Username : davidgmore E-mail: [EMAIL PROTECTED] On Sun, 19 Mar 2006 15:17:11 +1100, David Guest wrote:
> Tom Bowden wrote:
>
>> The main point I'd make is that if you can design a health system that puts the GP in a good
>> position to manage his or her patients' general care then the GP is probably the best steward
>> of the patient's EHR rather than a repository somewhere in the ether. This was I believe the
>> main point of the article I quoted. Certainly, we are designing and implementing systems that
>> will allow the GP to be steward of summary patient record that he or she will allow another
>> provider with a relevant need to access this summary information when really needed. However a
>> major proviso rules out pursuing this approach in Australia at the present time. That proviso
>> is that to be successful an IT system architecture must fit within/support a health system
>> architecture and currently the Australian health system does not yet put GPs in such a
>> position to direct and manage patient care. To do so the GP needs patient enrolment,
>> capitation and perhaps budget holding as well.
>>
> I think we are getting there, Tom. NEHTA seems to agree with us.
>
> I hope if the architecture is right we can avoid patient enrollment and capitation. Only a few
> patients have more than one GP. (Well only a few of the sick ones that is.) Budget holding is not
> related to data management. It is a government tool to limit services and is intensely disliked
> by patients and doctors alike. We're only two years out from another election so I cannot see
> that happening for at least 3 years.
>
> With all due respect to the bureaucrats and specialist colleagues on this list, like you, I
> cannot imagine anyone other than the GP being either capable or interested in taking on this
> role. Even with NHfIT it's still going to be the GP managing the patient and their data, except
> the data is now on the other end of the ADSL / fibre.
>
> Cheers.
>
> David
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