As a physician, I agree with Thomas's comments. See additional comments below.
At 11:46 AM 1/24/2000 +1000, you wrote:
>"John S. Gage" wrote:
>
> > Brian Bray wrote:
> > >
> > > The more I think about EMR, the more I think of a document for each
> > > patient. No database or middleware needed ;-)
>
>Well, except for:
>
>- physician access (as noted by John)
>- administrative access
>- data filtering, querying and searching
>- security, encryption
>- visual filtering
>- multimedia
>- automated processing of populations of records
I might also add:
- real-time clinical decision support (typically rule-based systems -
generally requires structured data and use of a controlled vocabulary)
- recalls and reminders (probably subsumed in a couple of the categories above)
There are probably others, but these lists likely cover most of the major
categories.
> > You just have to ask yourself: how much do we really need to know about
> > patients? Do we need images, or just reports on images? Can we get
> > away with 90% historical data. Mike Roizen's editorial in the NEJM
> > seems to suggest that we can.
>
>It seems to me (as a non-physician) that there are two questions here.
>
>1. Are all the images (tests, scans etc) we make of patients necessary? (If
>not, there needs to be a process to reduce clinical practice to its
>necessary level for medical care to occur properly.)
This is true. The number one rule for deciding to order a test (lab, X-ray
or whatever) is: will the results change your management of the
patient? If not, then you shouldn't order it (occasionally there may be an
exception to this, but not often).
>2. If (once such a process has taken place) we have images, scans etc -
>i.e. ones we deem necessary, then surely they want to be available in the
>record. Why take them in the first place?
>
>- thomas beale
True again. If the test was deemed necessary and is used in determining
the management of the patient, then it certainly needs to be documented and
available in the medical record. All of the information may not always
need to be available in everyone's record, though. For example, the
radiologist (or radiology department) will need to keep the X-ray image
itself, whereas for my record on the same patient in family practice I
probably will just need to keep the textual radiology report. It might be
nice and even desirable for me to be able to access the image itself, but
it may not be necessary to do so.
Rob
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Robert R. Hausam, M.D.
Jordan Valley Family Health
3570 West 9000 South, Suite 100
West Jordan, UT 84088-8811
(801) 569-1999
(801) 569-2001 (fax)
[EMAIL PROTECTED]
[EMAIL PROTECTED]
www.jvfh.com
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