William E Hammond wrote: > Maybe we Americans are the only ones who screw up, but one of the reasons I > have to remove data from the EHR is when the data manages to get into the > wrong patient's record. Unfortunately for every right way to do something, > there are many wrong ways. I have said that if I did not have to design > for human errors, I could do the work 4 times as fast. > > Result, we need to have the ability to remove data physically and > completely from the EHR. To leave the data is a breach of privacy. > Hi Ed,
I am glad you brought that one up...we also thought about this scenario specifically in openEHR, based on evidence e.g. in Queensland state health service - about 4m consumers - there are from memory 200 merges a week and 3 demerges - which is the scenario you mention. So it's part of life with current systems, human error etc. The merge situation (1 patient has 2 records assigned to them, then we find out later it is the same person) is described in some detail in section 6.2.7 of http://svn.openehr.org/specification/BRANCHES/Release-1.1-candidate/publishing/architecture/rm/common_im.pdf . So far we have chosen to use logical deletion to perform the demerge, which satisfies medico-legal reqirements (e.g. for the physician's protection, a drug they give might be based on the evidence of a problem or diagnosis wrongly put in the patient's record; removing that information later leaves the physician with no legal protection), but might not satisfy privacy requirements, if there is an easy way for someone to see patient B's information (which they normaly don't have access to) inside patient A's record (which they are allowed to see). But most likely the wrongly inserted information will appear to be patient A information - there won't be any indication that it was actually about patient B (assuming it was entered by a physician or nurse wrongly using patient A's EHR). There might be other ways it could get there, but in openEHR, if the info was put in record A, there is no way to know it was meant for somewhere else. - thomas beale -- ___________________________________________________________________________________ CTO Ocean Informatics (http://www.OceanInformatics.biz) Research Fellow, University College London (http://www.chime.ucl.ac.uk) Chair Architectural Review Board, openEHR (http://www.openEHR.org)
