On Sat, Mar 05, 2005 at 10:22:27PM +1000, Bigpond wrote: > "That is not feasible" > > And that's the problem that will keep the technical people in > money for years to come. >
$$$ Cheers $$$ ;-) > Not only must it be feasible it will be demanded by judges and > courts if the EHR is to ever be truly adopted. Even now we have > rules that all e-mails where a decision is made must be printed > out! The paperless world has never been to court. It is, but a matter of time. In this case, may take varying amount of time in different countries, but then technology will finally prevail. Do you recall a few decades ago when ball point pens first made an appearance in the market ? It took some time for banks and courts to accept documents signed in ball pens ! But then, that was a relatively minor thing when compared with a digital transition. And we have all forgotten ! The main issue here is varification of authenticity of digital data entry. There must be some mechanism to ensure that every entry placed in the EHR must be authenticated by the signitory, even if the entry is made by a secretary, DEO or transcription- ist. Once a fail proof method is evolved, the legal process would gradually yeild. The value of the signed hard copy is aithenticity, not content. It is this issue that we need to address. > It is feasible of course but complex. Authentication must be ensured in spite of the complexity. There is no alternate recourse. > Flags are set when pages are viewed, there are intricate audit > trails (terabytes). Audit trails of visits are only to ensure read access by authorised agencies. What is more important is 'write access' authentication, by best means as commensurate with available technology. No doctor should be in a position to deny that 'this medicine was not prescribed by me' or 'this is not my report' at any stage. > The fact that no one is doing it yet is that the litigation > costs haven't risen high enough to balance the need to do it. > Once a few specialists are sued for activities that can not be > supported by the record and they known they were innocent then > we will see some very interesting changes, either a > reappearance of paper records (personal) or a new paradigm of > image capture. IMHO of course. It would be inappropriate to wait for litigation processes to bring in the change. The thought process would have to be built in right from scratch, and refined as technology advances. For a start we could start with password/ paraphrase protected write access, or GPG/ PGP or maybe thumb imprint ... But then this is an important issue, and you just can't bypass the Law anywhere ... Dr USM Bish Bangalore - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
