Hi Karsten, Thanks for the response. Comments in text.
-Thomas Clark ----- Original Message ----- From: "Karsten Hilbert" <[email protected]> To: <openehr-technical at openehr.org> Sent: Tuesday, May 06, 2003 5:05 AM Subject: Re: openEHR security; Directed to Thomas Beale > Thomas, > > apologies for I at times respond a bit too rashly :-) > > I was not trying to advocate to just base decisions on what > the patient tells me. I was just struck by the example: > patient with elevated temperature, coughing and slight > difficulty breathing (generally feeling unwell) just having > arrived from a known SARS area. My response was simply based > on those facts and the only sane (clinical) response is to > get the patient to the next infectious diseases ward > relatively quickly for further assessment. This is, of course, > coloured by my working in a clinic, not a hospital department. > My hope is that clinics are connected locally, regionally, nationally and globally in a peer-peer network with lots of interaction. Information must flow freely with no borders. The SARS situation shows that this is a requirement. Globally we are lucky! Considerable effort have gone into configuring systems that can handle a global population and related Public Health issues. Technology presents no impediment; politics and funding do. Travelers are being scanned, their backgrounds checked and prior information checks performed, some related to Healthcare alerts. It is a small step to include connections to the departure and arrival Healthcare systems and related databases. Since we are spending billions on security of this type the connection should be a necessary addition; at least the Public Health people seem to think so. It would be a great tool especially since the economic benefits would be significant, i.e., the SARS situation has shown what emotions can accomplish. Unless you are planning on an early retirement, etc., it is feasible in the short term. It is an easy sell; try Canada. > However, it would certainly be very wonderful to be able to > access OpenEHR()ed records from the backwaters of China but I > wonder if I'll live to see that happen (I'm 28). So, yes, > electronically available pre-recorded information is very > helpful and OpenEHR is immensely useful at any of those parts > of dealing with the above patient. > > > obvious bump on the head (swollen). The Emergency Room nurse > > retrieved my name and address and then asked if I was in pain. Being > > Irish is a detriment at times, but I managed to respond that I was indeed > > in a lot of pain, was unable to stand, could not drive a car, and a prior > > neck injury was causing considerable distress, all of which was already > > on the record (same hospital and ambulance technician record). > Your current assessment of a situation is just as valuable as > what is recorded somewhere. I routinely do ask patients for > about the same information (or more specifically their current > assessment of said information) that they have provided > previously. It does help to establish a clinical path > beforehand such as "We will attend to alleviating your current > discomfort right away but I must re-assess some information > because some of the further treatment may alter your > perception of it." I have generally found patients very > responsive to that explanation. It takes about 2 seconds. > > Karsten Communicating with the Patient is vital for the Patient and the practitioner. The practitioner must work with an adjustable bar, i.e., communicating with a Taxi driver is unlike applying the same approach with a Medical doctor. Medical history (assuming an unknown at the time of the communication) is a factor; asking a Patient with a history of pain if they are in pain has to be different from one that just started. Patient expectations are reasonable, usually. They expect some action soon, and it should be proper and timely. I, for one, expect communications to be direct, to the point, on a reasonably high intellectual level and not repetitive. I also avoid British Army nurses. Repetitive questions about the obvious is frustrating. Give me a significant news item or a good joke. I'll last a lot longer that way. -Thomas Clark > -- > GPG key ID E4071346 @ wwwkeys.pgp.net > E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346 > - > 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
