Hi there: In Mexico we have a very similar perspective from Canada's. Although not an independant bank, since the EHR is intended to be created and used for the Mexican Social Security Institute, which serves 50 million patients, our architeture revolves around a centralized repository that will be shared by the continuing healthcare services held (outpatient, inpatient, ambulatory care, homecare).
The EHRS are peripheric to this "bank" of information that only hold the clinical/patient administration information generated from them. On this architecture policies on systems are important, but do not guarantee a functional and reliable model, since interoperability, data structure, buissness rules, security, integrity, etc. must be taken into account all around the environment that generates, requests, holds and communicates this information. As you state laws and economics do impact directly the model, legislation on all countries on the matter of "electronic information" are crucial, here the Ministry of Health recently approved to accept electronic clinical information as legal basis for any juridic events in helathcare, before this all EHR information (even RX images) we had in databases HAD to be printed in order to be legally accepted! I am sure the EHRS Standard is a great way to start, but for sure there is much to do in the matter of a consensed model that we can truely consider an EHR model. Ghislaine -----Original Message----- From: Ron Parker [mailto:[email protected]] Sent: viernes, 05 de septiembre de 2003 6:56 To: Amnon Shabo; Peter Schloeffel Cc: ehr at lists.hl7.org; openehr-technical at openehr.org Hello Amnon and Peter: Here in Canada we are attempting to define how the EHR should work in a publicly-funded healthcare model, and we have come up with an approach that is similar to this concept (although not so advanced as the "Independent Health Record Bank". It is our belief that the EHR is a repository external to current operational systems (realistically, a regionally dispersed set of repositories) that holds a consolidated set of person-centric health information. The repository is populated and queried by clinical / administrative systems using a standard set of messages. This logical repository is supported by: a set of shared registries (for client, provider, and location), services, policy, and privacy rules that allow interoperability of the data across sources, uses, and governance boundaries. The EHR plus the supporting infostructure we call EHRS. In this model the EHR exists to support organizational and service delivery interoperability across the spectrum of Health services. You can see more of our approach on our web site at http://knowledge.infoway-inforoute.ca You need to register with our site to see the EHRS Blueprint report, but I think you may find it interesting. This is very similar to your suggestion, and I think a very interesting way of thinking about and, perhaps even better, providing the business case to make such a shared repository possible. Looking forward to further dialog on this concept. Ron G. Parker Director of Architecture Canada Health Infoway - Inforoute Sante Canada 1000 Sherbrooke St Ouest, Suite 1200 Montreal, Quebec H3A 3G4 Toll Free: 866.868.0550 Office: 514.397.7988 Fax: 514.868.1120 rparker at infoway-inforoute.ca http://www.infoway-inforoute.ca -----Original Message----- From: Amnon Shabo [mailto:[email protected]] Sent: September 2, 2003 18:02 To: Peter Schloeffel Cc: ehr at lists.hl7.org; openehr-technical at openehr.org Subject: Re: ISO EHR DEfinition, Scope and Context TR second draft Peter, I was very glad to read the new section in the above report on pages 30-31 which includes the notion of "The Consolidated Shared EHR Model". In the TEHRE-2001 conference (where we met for the first time if you recall...) I've presented a paper on the vision of Indepenedent EHR Banks which actually susggest a consolidated model and a way to implement it worlwide. I stronlgly believe that this is the inevitable solution to the EHR interoperability challenge. However, this is not a "systems" problem per se. It is not just about a federated EHR system versus a consolidated EHR system. It's not only about technology. I believe that this is a broader problem which involves ethics, law, and economics. In a nutshell, I suggested that medical records will not be kept anymore by healthcare providers, rather they will be sustained for the entire lifetime of an individual by new players in the healthcare industry- "Independent Health Records Banks" which will be independent of healthcare providers, insurers, and government agencies, regulated by new legislation though. The fundamental principle of that legislation is that the copy of a medical record stored in such an EHR bank is the only medico-legal copy. The record is sustained objectively by an EHR bank and all authorized parties can have access to it. Such a bank acts as a custodian/trustee. Multiple competing banks will be established by private enterprises (once the appropriate legislation will be in place), much like financial banks. Healthcare providers could reduce their costs of medical records archiving as this function will be carried by the banks. Insurers will support it as it will improve the quality of care their customers get. Privacy will be better protected as no global patient identifiers will be needed since a bank account number will be the only access key you need. And most importanty, truly longitudinal EHRs will finally emerge out of the raw attested medical records by advanced information technologies employed by the EHR banks. For more details, attached please find the full paper (a revision). (See attached file: WhosAfraidOfLEHR.doc) Thanks, Amnon. ------------------------------------------ Amnon Shabo (Shvo), Ph.D. Life Sciences Solutions IBM Research Lab in Haifa "Peter Schloeffel" <peter.schloeffel at oceaninfor To: <Linda.Fischetti at med.va.gov>, <ehr at lists.hl7.org> matics.biz> cc: Sent by: Subject: ISO EHR DEfinition, Scope and Context TR second draft owner-ehr at lists.hl7.org 31/08/03 07:41 Please respond to "Peter Schloeffel" Linda, here is the updated draft of the ISO EHR Definition, Scope and Context TR as promised some time ago.? This draft will be discussed at the upcoming TC 215 joint working group meeting in Denmark in early October. The second draft contains a number of changes in both content and structure of the document compared to the first draft which was used as the basis for discussion at a special project meeting held in Sydney on 19 July. I have hopefully captured the main points and suggestions/requests for changes from that meeting. The main changes from the previous (V0.1) draft are: ?1 Background ? rewritten and condensed ? I have deleted most of the source material which appeared in the V0.1 draft to make this closer to the structure and content of a formal ISO TR. ?2 Purposes and scope of TR ? new ?3 Terms and definitions ? new ?4 Definition of the EHR ? extensively revised ?5 Scope of the EHR ? little change from the previous version ?6 Context of the EHR ? reorganised and a few changes ?7 EHR systems ? extensively revised Since I will be overseas for 4 of the next 6 weeks, I will not be doing another draft update before the ISO meeting but I would welcome comments from the EHR SIG, which I will use for the post ISO meeting third draft. I will also be at the Memphis meeting so will be happy to discuss any issues with people there. Regards Peter openEHR ? the ATM of healthcare ************************************************ Dr Peter Schloeffel Director and CEO Ocean Informatics Pty Ltd Managing Director EHRcom Pty Ltd 30 Winchester Street St Peters? SA? 5069 Australia Tel:??????? +61 (0)8 8363 1642 Fax:?????? +61 (0)8 8363 3481 Mob:???? +61 (0)414 669 899 peter.schloeffel at OceanInformatics.biz www.OceanInformatics.biz www.openehr.org ************************************************ [attachment "EHR Definition_Scope_Context Draft TR v0.2.1.doc" deleted by Amnon Shabo/Haifa/IBM] --- To access the Mailing List archives, go to: http://lists.hl7.org/lyris.pl?enter=ehr --- To access the Mailing List archives, go to: http://lists.hl7.org/lyris.pl?enter=ehr Este correo fue revisado por Webshield E500. IMSS - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
