Hi Dennis, The personal card is a great approach. Unfortunately there are many people who will not have access to the cards. Alternate means could be employed to handle the IDs.
Multiple ways of generating/retrieving the Patient's ID should be available. The smart card is a good approach for many other reasons as well, e.g., storage of critical medical information. -Thomas Clark ----- Original Message ----- From: "Denis Nosworthy" <denis.noswor...@swsahs.nsw.gov.au> To: "'Tim Churches'" <tchur at optushome.com.au>; "Sam Heard" <sam.heard at bigpond.com> Cc: "Christopher Feahr" <chris at optiserv.com>; <lakewood at copper.net>; <openehr-technical at openehr.org> Sent: Thursday, August 07, 2003 4:05 PM Subject: RE: Distributed Records - An approach > > I have been reading these threads with interest over the last few days and I > think the majority of the comments are extermely value and add to the > debate. The focus is obviously on the structure and some of the mechanics of > the process but let me throw something else into the melting pot that is an > issue which does not seem to have received much airplay in the recent past > anyway. > > It is the issue of identification and matching of clients. > > Far be it from me to raise the Australia Card issue again but the EHR ain't > (excuse my English) going to work unless the industry can crack this nut in > such a way that it is universally accepted by most Australians. > > Research that we have done over the past couple of years has indicated > clearly that the majority of people we have surveyed (upwards of 3000 as > part of another project) appear to have little concern about using an EHR > however enacting the implementation of an "Australia Card' is another issue > altogether. > > I would be interested in the comments from those who have been close to the > action about what their own views are and what they perceive the client view > to be. > > Regards, > > Denis Nosworthy. > CIO, South Western Sydney Area Health Service > > -----Original Message----- > From: Tim Churches [mailto:tchur at optushome.com.au] > Sent: Friday, 8 August 2003 06:49 > To: Sam Heard > Cc: Christopher Feahr; lakewood at copper.net; openehr-technical at > openehr.org > Subject: RE: Distributed Records - An approach > > > On Fri, 2003-08-08 at 06:06, Sam Heard wrote: > > Christopher > > > > It has been good to read this thread - but I have to wade in here. In > > designing openEHR I have had a few principles in mind. > > > > 1. The technical solution should impose no constraints on social > > behaviour. This means to me that if we want one EHR for each person > > that is patient held or one repository for the entire country the > > system should work. > > This is the only correct approach. Small, limited scope EHRs can always be > amalgamated later to create larger scope EHRs. However, grand, > all-encompassing EHR schemes are, at this stage, in most countries, bound to > flounder on both socio-political and technical rocks. We should be worry > about crawling across the room competently first, but forearmed with the > knowledge that in a decade or so we will be running marathons (and hence > should start out with an approach which can go the distance > apologies for the mixed metaphors there). > > > > > 2. Linking records is non-existant at the moment and we can move > > incrementally towards an environment where we know where health > > information about an individual resides. Once you start to send EHR > > data from one site to another in openEHR then the links will build > > automatically. Remember, sometimes the patient will not want their > > information to flow! and while the technical view of security checks > > seems omnipotent, partitioning will always be safer. > > Every Monday morning, anyone working in this field should re-read the BMA > criteria for privacy of patient data, as drawn up by Ross Anderson in the > mid 1990s - see http //www.cl.cam.ac.uk/users/rja14/policy11/policy11.html > > A few moments reflection on these principles reveals that there are many > very complex problems for which definitive or even satisfactory solutions > don't yet exist - for example, if a patient consents to access to their EHR > by clinician A, under what circumstance can that consent be extended to > other clinicians, and is the extension of consent transitive, and/or > commutative? This extends to knowledge that an EHR record for a patient > exists (or even that the patient exists), not just to the contents of that > EHR. Very tricky stuff indeed, which is usually swept under the carpet in an > intra-institutional setting, and increasingly in vertically integrated > healthcare organisations - but organisation won't be able to do that > forever, and these issues certainly can't be ignored for community-wide > EHRs. It will take many, many years, and many many (probably failed) > attempts before well-accepted solutions to these problems are available. In > the meantime, start small... > > > > > 3. openEHR offers a one to one transform for all information in EHRs. > > Our idea is that openEHR servers will retain the comprehensive > > information that comes from legacy or specific systems. Other systems > > will develop their read and write interfaces with openEHR and that > > will be all they need (at some future date) to operate and > > interoperate with EHR systems. Could be fantacy but it looks sweet - > > we are moving to a real-time trial of this approach in Australia. > > Which means that release of a production-quality open source openEHR kernel > is approximately how many years away, more or less? > > Tim C > > > > > Cheers, Sam > > > > > -----Original Message----- > > > From: owner-openehr-technical at openehr.org > > > [mailto:owner-openehr-technical at openehr.org]On Behalf Of Christopher > > > Feahr > > > Sent: Wednesday, 6 August 2003 12:59 AM > > > To: lakewood at copper.net; openehr-technical at openehr.org > > > Subject: Re: Distributed Records - An approach > > > > > > > > > Thomas, > > > This sounds workable to me. If I am understanding you correctly, we > > > need one (and only one??) registry in which anyone, anywhere (who is > > > authorized, of course) could look up a patient and determine which > > > "region" had master control at the moment over his record. If I'm a > > > provider living in the region where the records are primarily > > > managed, then when my system attempted to look up, say, the date of > > > his last Tetanus vaccination, it would find it immediately. If I > > > was a provider visited while the patient was traveling outside his > > > "home" region, then the same local query about his tetanus shot > > > would tell me: "hold on a minute, while we search all known > > > registries to see where this guy's home-region is... where his most > > > current records will be located". ... and then my region does a > > > full record update from the current home region? or just try to > > > display his tetanus vaccination history? > > > > > > One of the problems alluded to is that different regions might be > > > using very different EHR structures. Thus a simple "record refresh" > > > in region B from the information stored in Region A is not so > > > simple. It would involve mappings at least, and possibly even data > > > transformation. The inability to assume an overarching authority > > > seems to be the Achilles heel. After a dozen record "movements" > > > from one region to the next, many little mapping and transformation > > > errors may have accumulated to thoroughly hose up the medical > > > information in the patient's "master" record. > > > > > > One way around the central record managing authority would be to > > > have VERY FEW regions... each with a well organized regional > > > authority... who come together under a global organization and work > > > out a very tight choreography for these refresh/hand-off operations. > > > But this sounds harder and no more likely to be created as one > > > single authority such as the UN imposing the requirements on all > > > regions. > > > > > > I believe that the most critical point for global standardization > > > and what we must aim for (first) is the information in the record. > > > When the world has settled into that (something that will ALSO > > > require a central authority, but just for standardizing what the > > > information elements mean, not for choreographing complex > > > record-merge operations), people will gradually come around to the > > > idea of moving to the next level of system interoperability, with > > > standard record structures. > > > > > > With only the information standardized globally, two large and > > > cooperative regions (say, US and Australia) could still choose to > > > create a US-Aus. information authority and orchestrate a high level > > > of interoperability for patients and providers floating anywhere > > > within our two countries. If the "functional regions" initially > > > were more along the sizes of counties and states, then we'd have a > > > lot more hassle and negotiating. So I would suggest the world start > > > with the largest sized regions that could be reasonably managed with > > > the same EHR structure. > > > > > > The critical issue for all regional participants would be a strong, > > > competent regional authority... that operated in conformance to a > > > set of well defined "regional authority rules"... maintained by the > > > UN?? > > > > > > Christopher J. Feahr, O.D. > > > Optiserv Consulting (Vision Industry) > > > Office: (707) 579-4984 > > > Cell: (707) 529-2268 > > > http //Optiserv.com > > > http //VisionDataStandard.org > > > ----- Original Message ----- > > > From: <lakewood at copper.net> > > > To: <openehr-technical at openehr.org> > > > Sent: Tuesday, August 05, 2003 12:11 AM > > > Subject: Distributed Records - An approach > > > > > > > > > > Hi All, > > > > > > > > With a background in fault tolerant computing I have a built-in > > > penchant for > > > > distributed files that are exact/backup copies of a master. Works > > > wonders > > > > for > > > > financial transactions. > > > > > > > > I don't believe that this model fits EHRs especially since one can > > > conceive > > > > of > > > > parallel, e.g., close proximity in time, operations directed at > > > > modifications originating at geographically distant > > > > locations.These operations, even > > > they > > > > occur > > > > across town (Clinic and distant Lab) create problems for record > > > management. > > > > > > > > Tying record management to physical location is not a solution. > > > > Remote medicine complicates this immediately. However, a constant > > > > occurs immediately, presuming that we do not have to deal with > > > > human clones (put a > > > <dash-number> > > > > in the ID). The Patient ID is it. Traditional approaches would > > > > require > > > that > > > > in all > > > > the world there is only one unique person being considered. > > > (hopefully). > > > > > > > > Hence each region could contain entries on residents, transients, > > > visitors. > > > > tourists, etc. that somehow make contact with healthcare > > > > facilities/Practitioners in the region. > > > > > > > > Registering the IDs and updating the regional databases requires > > > > that > > > only > > > > those > > > > regional Patients be administered. > > > > > > > > National and international databases can be established that will > > > receive > > > > and store > > > > regional registrations of Patient IDs, allowing one to scan these > > > databases > > > > to > > > > determine who holds regional records on individual Patients. One > > > > can > > > then > > > > retrieve all the records or part of them. This substantially > > > > reduces > > > the > > > > need for > > > > storage and bandwidth to manage records on a global scale. > > > > > > > > I presume that there is no need to have matching records for > > > individual > > > > Patients > > > > in all regions this Patient has been in an made contact with the > > > healthcare > > > > industry. If I take a cruise on the Rhine and require medical > > > attention it > > > > makes no > > > > sense to burden whatever region manages that healthcare system > > > > with > > > anything > > > > more than they had a tourist with a weak stomach. > > > > > > > > It would be nice to have a distributed registry that would show > > > > where > > > I had > > > > to > > > > stop off and get some help. At least the Public Health personnel > > > > would appreciate it. > > > > > > > > The important thing to me is to be able to access all the known > > > records and > > > > bundle them in a way that is appropriate for the healthcare > > > > personnel handling my latest complaints. > > > > > > > > BTW: The Fault Tolerant/Highly Available Systems can make sure > > > > that > > > the > > > > information requested is available but the applications have to > > > structure > > > > it. > > > > > > > > -Thomas Clark > > > > > > > > > > > > - > > > > If you have any questions about using this list, > > > > please send a message to d.lloyd at openehr.org > > > > > > - > > > If you have any questions about using this list, > > > please send a message to d.lloyd at openehr.org > > > > - > > If you have any questions about using this list, > > please send a message to d.lloyd at openehr.org > -- > > Tim C > > PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere or at > http //members.optushome.com.au/tchur/pubkey.asc > Key fingerprint = 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0 > > > > This message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of South Western Sydney Area Health Service. - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
