-----Original Message-----
From: Li, Henry
Sent: Tuesday, 11 June 2002 9:10
To: 'Denis Nosworthy'
Subject: RE: The concept of contribution
Hi
I am not a real techno but I understand and deeply interested in the
discussion. I had this vision of a real good electronic health record. It is
one own by the patient, carry by the patient, and presented to the health
care provider (whoever they are) by the patient (all over the world). The
Browser and XML or its improved version whatever it may be in the future is
the way to go.
This is the process
A patient visits a care provider and presents his e-card as a proof of
consent to treatment
The health care provider loads up the health record into the browser and
download the info into whatever system he is using (this applies to Hospital
as well), the health care provider can also choose to discuss the patient
with other health profession on line through the web.
When the patient leave the care provider, it is the responsibility of the
care provider to upload whatever he has done to the patient back to the
e-card and the patient goes away. Any subsequent test results etc, it is the
responsibility of the health care provider to contact the patient to have
the data put into the patient's e-card. (the patient can choose not to do so
- but it is of course to the patients benefit to do so)
The benefit of this is at any one time, the patient is the only person that
has a complete health history of himself and he owns it. (Solve the
ownership and privacy issue) After all, currently, the health care provider
will only know as much as what the patient choose to tell them anyway.
New industry will start up to take care of the situation and provide all
sorts of support to the e-card holders. These services include how to
download, how to backup or even help retrieve data in emergency etc. etc. -
god knows what will come up in the commercial world. Good or bad, no big
brothers.
When the patient dies, he can choose to sell his e-card for research
purposes and has money to bury himself - no burden to next of kin.
The reason I write these is that, I think I contribute as from a dumb user's
point of view, may be it has some bearing on the design and the structure of
the 'database' or 'rules' or whatever you may call it. The only
consideration will be where to put different types of health data in the
structure. It is upto the provider system to come up with the download and
upload method.
Cheers
Henry Li
-----Original Message-----
From: Denis Nosworthy
[mailto:Denis.Nosworthy at swsahs.nsw.gov.au]
<mailto:[mailto:Denis.Nosworthy at swsahs.nsw.gov.au]>
Sent: Tuesday, 11 June 2002 8:37
To: 'Sam Heard'; openehr-technical at openehr.org
<mailto:openehr-technical at openehr.org>
Subject: RE: The concept of contribution
<< File: InterScan_Disclaimer.txt >> Sam,
Well said.
We have for many years been operating under the ideas of
'interoperability'
and whilst tools such as HL-7 have been very successful in
getting us
through these times the issue of EHR interoperability will
be something else
yet again. Source system interoperability is one thing
however (mostly
constrained within a controlled environment) but receiving
systems such as
EHRs will have to be truly interoperable if they are to be
effective.
The EHR is not a messaging system as some would have us
believe (in some
incantations it could be seen to be just that) but it must
be a system that
clinicians can rely on to be accurate and reflect 'real
life'. If it has to
rely heavily on 'real time' messaging then the vagaries of
our
telecommunications systems will have a significant impact on
that level of
acceptance
-----Original Message-----
From: Sam Heard [mailto:sam.heard at flinders.edu.au]
<mailto:[mailto:sam.heard at flinders.edu.au]>
Sent: Tuesday, June 11, 2002 10:07 AM
To: openehr-technical at openehr.org
<mailto:openehr-technical at openehr.org>
Subject: RE: The concept of contribution
Dear All
There is no doubht that the solution will have a degree of
complexity - just
look at HL7 v3 which is aimed at messaging. I believe that
the HL7 and CEN
EHR approaches will align - and will include the level 3 CDA
demands -
though it will take some time and must arise through
implementation
experience. The time for smoked filled rooms and EHR
standards is over for
us at openEHR and Ocean Infomatics. It is very helpful to
have lots of
ideas, but unless people are working on an implementation it
is almost
impossible to contribute in a major way.
I have put the challenge to CEN to have some pilot
implementations of
Clinical Applications to GEHR (using our current trial
implementations) and
see what the implications are of our current approach. At
least 2 European
companies are interested.
I also believe that the EHR demands an information model
designed
specifically for that purpose - the interoperability of
EHRs. The fantacy
that sharing information based on different information
models will be
straight forward is evolving - one only has to look at the
difficulty of
sharing a word document amongst different software - it is
often close. The
order of magnitude of complexity with health information is
far greater.
So let us address the difficulties of information models, of
clinical models
in a two level approach and work to create an EHR that is
genuinely
interoperable. It will take resources - but to have it
working as a sharable
component will take 0.1% of about 3 countries health IT
development budget
and 10 good minds.
I think it is really starting to happen!
Cheers, Sam
____________________________________________
Dr Sam Heard
The Good Electronic Health Record
Ocean Informatics, openEHR
105 Rapid Creek Rd
Rapid Creek NT 0810
Ph: +61 417 838 808
sam.heard at flinders.edu.au <mailto:sam.heard at
flinders.edu.au>
www.gehr.org <http://www.gehr.org>
www.openEHR.org <http://www.openEHR.org>
__________________________________________
>
> >Why the focus on HL7 only? CEN/TC251 has started work on
the EN 13606
> >and
> is precisely what you want. HL7 version 3 and >CDA will be
to unstable
> for some time to come. HL7 doesn't adopt the GEHR (CEN)
two model
> approach.
> >Artifacts based on the present HL7 version 3 RIM will
prove to be
> unimplementable as a system or object.
>
> We can be very encouraged that you may get together with
HL7 on this.
> However you (or was it Gunnar Klein) did say in your
?Berlin CEN
> meeting 2002 presentation (the presentation has
disappeared from the
> www.openehr.org <http://www.openehr.org> . site) that EN
13606 had limited uptake because it
> was:
>
> a) incomplete or have offered only partial coverage of the
healthcare
> domain;
> b) unnecessarily complex;
> c) too generic, leaving the various implementations too
much
> variability in how the models are applied to a given
domain;
> d) flawed, with some classes and attributes not
implementable as
> published;
> e) requiring expensive re-engineering of systems;
> f) containing features not required by the
> purchasers of clinical systems.
>
> The time is evidently ripe for a synthesis. I agree about
the
> importance of
> narrative:
> You said:
>
> >It is a narrative for personal usage.
> >When information is to be shared the author will select
and rewrite
> >parts of his notes in order to meet a specific request by
an other
> >healthcare
> provider.
> >This is the way people work. This is the way healthcare
> providers know how
> > to work with using paper systems.
>
> Perhaps the record is a resource to make stories out of?
The original
> 'syntagm' is just the first, and even that was an
interpretation.The
> 'true' story is unknowable.
>
> > I can see that objective information (orders, test
results) can
> be shared
> by
> > all without real problems. But people (good healthcare)
will need
> subjective
> > narrative as recorded in their personal Medical Records.
>
> Free text remains indispensable, structured data is just
the debris
> left behind - it's a point of view...
>
> Regards
>
> Mike Mair
>
>
>
>
>
> -
> If you have any questions about using this list,
> please send a message to d.lloyd at openehr.org
<mailto:d.lloyd at openehr.org>
>
-
If you have any questions about using this list,
please send a message to d.lloyd at openehr.org
<mailto:d.lloyd at openehr.org>
-
If you have any questions about using this list,
please send a message to d.lloyd at openehr.org
