Hi Karsten, Comments in text.
Regards! -Thomas Clark Karsten Hilbert wrote: >>"That is not feasible" >> >>And that's the problem that will keep the technical people in money for >>years to come. >> >> >I am not a technical person per se. I am an clinician. > > > >>Not only must it be feasible it will be demanded by judges >>and courts >> >> >Surely, courts and judges have been known to demand and >accepts proofs that aren't proofs before. They'll learn, too, >what things need to be taken to mean. > > > Legal systems tend to be autonomous in the sense that the remainder of society must conform to the laws and Judicial interpretations thereof. They tend to rely upon prior interpretations and modifications to the law and demand that suggestions for change be substantiated beyond 'some' unpublished standards, e.g., genetics is provable since it is consistently reproducible beyond statistical norms while 'Lie Detectors' are still struggling. Courts are not likely to be interested in learning about EHRs other than how to use them in related cases as evidence that supports or defeats positions. EHRs supply content, which can be taken out-of-context and which suffers from the common maladies, inconsistent, incomplete, etc. In this way they are very similar to paper records, i.e., Taken together, what do they convey to the Court. Whatever legal problems the Healthcare Industry now has with paper records may remain with EHRs, and some new ones may be created due to the new technology, e.g., a paper record can be locked up in your Safe Record Repository, an EHR can be archived on the Internet and available to Hackers. >>if the EHR is to ever be truly adopted. >> >> >Too pessimistic, IMO. > > > The EHR will be adopted and hopefully Legislatures will make new, appropriate law. >>Even now we have rules >>that all e-mails where a decision is made must be printed out! >> >> >Which is akin to photographing every screen you view. > > > If the content is crucial then make a record of it. >>The paperless world has never been to court. >> >> >In a court one not always has to provide a waterproof trail of >evidence. There is "substantial evidence" (is that what it's >called ?). And there is "demonstration of due course" which >adds a lot of weight to what otherwise are simple assertions. > > > Admissible "Substantial evidence" permits inference and deduction while admissible evidence of a "course of conduct" for an individual, an association or an industry can be used for a variety of purposes to 'tip the scales', EHRs may well be viewed as being more 'form' than 'function', i.e., the content is similar to that derived from paper records. >>It is feasible of course but complex. Flags are set when pages are viewed, >> >> >Those flags do not document what you want them to document. >Such a flag only documents that it was set. Everything else is >"due course". Eg. if the flag is set "it is reasonable to >assume" that it was set by the software the doctor claims to >have used. Also "it is reasonable to assume" that the doctor >thus "saw" what that program would display in conjunction with >that flag being set. No hard proof there. > > > Flags are a problem and can be subject to multiple interpretations. >>there are intricate audit trails (terabytes). The fact that no one is doing >>it yet >> >> >Why do you think this is a fact ? > >Karsten > > - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
