Of course MediConnect performed similar functions with a medication record.
Major issues for any repository are:
* authentication, especially of patients
* authorship of the "latest version" and what happens to "other
versions by other providers"
* security, esp access control
It is way easier to do in the UK where every person can *only* have
one GP - there is no confusion about who can write to the record.
It is unclear from the little public information about whether these
problems have been solved.
http://www.nhsborders.org.uk/view_item.aspx?item_id=17821
Ian.
At 11:18 am +1000 30/4/06, Tim Churches wrote:
Peter MacIsaac wrote:
Thanks to Geoff Miller for passing on this one
http://www.ehiprimarycare.com/comment_and_analysis/index.cfm?ID=137
While technically this is not so challenging as all the data comes from one
system, what is interesting is the consent model used - patient consent
"just in time" when their afterhours care doctor needs to access the
information (as well as having an option to opt out - so far only a handful
after what is described as an extensive publicity campaign, and a robust
audit trail model
Hah! While the Poms south of Hadrian's Wall are spending billions of
their valuable pounds trying to set up a Rolls-Royce shared Clinical
Records Services, without a lot of success so far, those canny Scots
have spent a tiny fraction of that to get what sounds like a substantial
set of benefits, and now, not in another decade.
The article notes that they will be adding feeds from other GP software
systems, but yes, only one so far (GPASS). However, apart from the
consent model, the notable thing about this system is that they collect
very little data - just current medications, repeat medications and
allergies plus basic demographic information. This seems a rather
sensible place to start as the availability and completeness of those
data items in current GP information systems is likely to be quite good,
and the semantic issues of what the data actually mean are manageable.
By comparison, there are rather more issues to be sorted out for a
shared EHR which can accommodate opinions on whether a patient does or
doesn't suffer from borderline personality disorder, or even one which
purports to record something as apparently simple as current BP - see
http://oceaninformatics.biz/archetypes/MindMap/ArchetypeMap.html and
click on BP or some of the other observation types to see what things
need to be considered and/or recorded.
Of course, if the aim is just to make an electronic facsimile of
hand-written patient notes available online, in a form which is only
meaningful to highly trained humans, then much of this is overkill. many
EHR projects seem rather schizoid on this point - they make statements
about "enabling automated decisions support and quality assurance", but
when it comes to having to represent the necessary data in a
machine-understandable fashion, it all gets a bit tricky and we end up
with some text boxes on a screen in which free-text notes can be
cut-and-pasted. better than nothing, I suppose, and perhaps a necessary
stepping stone.
But the biggest issue is whether the GP types these things into his/her
rinky-dinky little microcomputer in the first place. If the `puta is
only being used as a script writing tool and no more - which is the case
in a large number of Australian practices, I would suggest - then the
Scottish EHR data items of basic demographic information, current
medications, repeat medications and allergies seems rather realistic.
Tim C
--
Dr Ian R Cheong, BMedSc, FRACGP, GradDipCompSc, MBA(Exec)
Health Informatics Consultant, Brisbane, Australia
Internet: [EMAIL PROTECTED]
(for urgent matters, please send a copy to my practice email as well:
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