Hi Tim, Never trusting the record is in itself justification for OpenEHR and interfacing it with all other EHR/EPR/EMR systems. I do not 100% trust the contents of the records supported by the EHR/EPR/EMR systems. The basic rationale is that the information is generated by related devices and human beings, e.g., the process of communication between humans is not without difficulties.
What these record systems do is generate and maintain accurate and precise records of what someone has reduced to an electronic format. One could employ software applications that would attempt to make sense out of it and perhaps provide a more "relevant"/"germane" interpretation, but the record remains. I can understand that Practitioners suspect the record. Mine involves multiple Practitioners in multiple Healthcare organizations (I have moved some). They do not speak the same 'language', which is probably why the Patients are subjected to multiple identical tests for no obvious reason. The record systems will not improve the "correctness" of the content. A bad diagnosis remains just that. The record system will make it available quickly and reliably. Another software application may put together some of the pieces so that an improvement is possible, but then a Practitioner would probably have to design that as well. Not trusting the content of the records is a Practitioner problem. Electronic records are likely to remove most of the problem areas in existing systems, e.g., the copy machine ate that page. A group of monkeys locked in a room with a number of computers taking record-based inputs may create actual records but neither of us could really understand or use the data. This comes from the same scenario applied to music. Bach would have no competition. I have one hope for the Patient's sake; the Practitioners should at least rotate the questions. -Thomas Clark ----- Original Message ----- From: "Tim Churches" <tc...@optushome.com.au> To: "openhealth-list @ minoru-development . com" <openhealth-list at minoru-development.com> Cc: "Karsten Hilbert" <Karsten.Hilbert at gmx.net>; <openehr-technical at openehr.org> Sent: Monday, May 05, 2003 3:10 PM Subject: Trusting the contents of EHRs > > --=-O//NjGR3MyktaTNFkz0f > Xontent-Type: text/plain > Content-Transfer-Encoding: quoted-printable > > Cross-posted from the openehr-technical list: > On Tue, 2003-05-06 at 03:39, Thomas Clark wrote: > > The presumption that a Patient is 100% lucent in a stressful situation is > > subject to debate, e.g., accidents, flu, labor and delivery. > >=20 > > Retrieve the information from the Patient; analyze it; compare it with th= > e > > record, if available, but give it a proper weighing. Don't forget the > > symptoms and the reasons the Patient ended up in the facility. > >=20 > > It is an information retrieval/analysis/credibility/reliability problem. = > The > > information needs to be sorted. > > About a year ago a friend of mine suffered a myocardial infarct at the > unexpectedly early age of 53. Thanks to very swift thrombolysis, he > survived with virtually no ill effects. However, during his stay in > hospital, he was amazed that he was asked the same basic set of > questions over and over again by different people, despite them having > his clinical record in front of them, with that information neatly > recorded there by an intern. He found that surprising. > > When he related this to me, I expressed no surprise at all - one of the > first things you learn as an intern working in a hospital is that you > should never trust the accuracy or completeness of someone else's entry > in a medical record. So wherever possible, you always check the facts. > Later, doing general practice locums, the wisdom of that view was > confirmed. But I learnt to rely on records made by colleagues whom I > knew and trusted. > > Now, this is, I suspect, a rather common attitude, and is something > which seems to have been rather glossed over in all the discussions and > studies of the benefits of an EHR. There's no doubt that, eventually, > medical culture would change sufficiently to trust what is in an EHR, > but how long would that take? Has anyone systematically investigated > this question? > --=20 > > Tim C > > PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere > or at http //members.optushome.com.au/tchur/pubkey.asc > Key fingerprint =3D 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0 > > > --=-O//NjGR3MyktaTNFkz0f > Xontent-Type: application/pgp-signature; name=signature.asc > Content-Description: This is a digitally signed message part > > -----BEGIN PGP SIGNATURE----- > Version: GnuPG v1.0.7 (GNU/Linux) > > iD8DBQA+tuE4eJFGqer5k9ARAvcnAKC4+s0dhOX6KBwNDTJ5C7Alu7hdlACfeqsT > pdIExqkFcaqZ4QU57Xf2saM= > =K4OW > -----END PGP SIGNATURE----- > > --=-O//NjGR3MyktaTNFkz0f-- > > - > 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
