Christopher Wurm wrote:
I work part-time in a Mental Health Community Treatment Team employed by
a Public hospital and part-time in private practice as a GP
psychotherapist. One day last week I copied and pasted text from an
email about a patient into the "progress" notes on MD2. Then I opened a
different patient 's file. The email was in the progress notes of
patient 2.
Then I opened a different patient 's file. The email about patient 1 was
in the progress notes of patient 3 along with the progress notes of
patient 2.
Then I opened a different patient 's file. The email about patient 1 was
in the progress notes of patient 4 along with the progress notes of
patient 2 and patient 3. And so on for the rest of the day. I made sure
I showed the screen to a colleague who has been keen to promote MD2 as
our setting was previously not computerised apart from the use of email
and the internet. We are about to go to MD3. I am actually a Genie user
in my private practice and keep wishing I could persuade the hospital to
invest in a better program. I have looked at MHAGIC, thanks to this list
and it looks promising.
If patient 2 or 3 or 4 wants to see their file, we will be revealing
confidential details about all the others seen that day. This would be
bad enough in a GP setting, but for someone paranoid, who is wary of
revealing their private thoughts to clinicians who have obtained a
Community Treatment Order, compelling them to have antipsychotic drugs
they dislike, you can imagine this is especially unhelpful!
Once this happened before and it seemed to disappear later on. But these
glitches seem to be preserved for eternity. Adding extraneous details to
a file seems pretty shabby. In wonder how often bits disappear without
trace.
What's going on? Will it keep happening with MD3? Has anyone ever seen
this with BP or Genie?
Christopher,
Sometimes this sort of issue occurs in MD2, owing to the limitations of
the database technology it uses. Sometimes re-indexing and file-repair
fixes it, sometimes the misallocation has to be fixed manually by
someone familiar with the technology who edits the UR_No's that link
notes, scripts and everything else to a particular patient.
That person will also need some clinical input, as what should go where
and the pattern of the misallocation isn't always transparent. I did
some of this at a practice in Sydney last Friday, which has it occur
intermittently.
This problem is the main rationale for MD3, which uses a
claimed-to-be-more-robust database technology called MS SQL. Best
Practice also uses this database technology, and also NxtHealth, the
successor to Medical Spectrum. Other clinical software packages commonly
in use, such as Medtech and Profile, use Interbase, and Genie uses one
called 4D.
We are all hoping MD3 eliminates these sort of problems. In the
meantime, if you can find a local support person who has experience with
fixing these corruptions, you may be able to reconstruct the patients.
In my experience it only happens intermittently to small numbers of
patients. Many MD2 users never see this problem.
If it is happening more extensively you are in big trouble and need to
look at your whole system very seriously. One of the known causes is
having many fast workstations accessing the MD2 database on a slow
server. There are other causes that are known and many that are never
identified in particular instances.
MD recommend running the file, repair and re-indexing AFTER A FULL
BACKUP as the first step.
Greg
--
Greg Twyford
Information Management & Technology Program Officer
Canterbury Division of General Practice
E-mail: [EMAIL PROTECTED]
Ph.: 02 9787 9033
Fax: 02 9787 9200
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