There are undeniably enormous challenges in this area. However, right now, we have a health system that operates off bits of paper augmented with IT here and there. Can we verify the authenticity of a medical record from the 1970s today? Will a paper health record created today be authenticated in 2030? If a doctor receives a medical history on paper and one of the pages has a fold on the corner which causes two pages to be turned instead of one, can we prove in a court today if the doctor did or didn't see the information on the second page? Hey, forensic science isn't that good even on CSI :-)
Surely the goal of EHR is to do better than the existing systems in some areas (so there is benefit in choosing EHR), and no worse in others (so there is no significant detriment)? For example, won't some patients have better outcomes because their doctors have access to their past allergic reactions thanks to an EHR, even if we cannot prove in a court whether the information did or didn't get rendered correctly on a computer screen? If we are serious about proving in court "what the doctor saw", I can only suggest that we create a head-mounted device with a camera (positioned at eye level) and microphones positioned at ears and mouth and record every second of the doctor's working life as evidence of what they saw, heard and said. Of course, it cannot prove whether those images and sounds were processed cognitively or not, which is what you need to establish to go from "what the doctor saw/heard" to "what the doctor knew". It is easy to overlook something on a page or on a screen, despite it being in plain view. If people or organisations perceive significant benefit from technology, they will not wait for the technology to be perfected. They will weigh up the risks and benefits and proceed accordingly. As an example, many people used analogue mobile phones for years despite widespread public knowledge that they were not completely secure, but obviously felt that the benefit outweighed the risk, no doubt figuring that nobody would be motivated to eavesdrop on their basically boring conversations. A few people suffered because their conversations were not secure (e.g Prince Charles!) but most people had no adverse experience. This is not to say that we should not try to solve the problems that are being identified, but I doubt the lack of immediate solutions will be a showstopper to many organisations or nations rolling out EHRs if there are other compelling benefits. Kerry, who thinks there is a need for an openehr-societal mailing list for this kind of discussion Dr Kerry Raymond Distinguished Research Leader CRC for Enterprise Distributed Systems Technology University of Queensland 4072 Australia Ph: +61 7 3365 4310, Fax: +61 7 3365 4311, www.dstc.edu.au - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
