Thomas Beale wrote:
> - physician access (as noted by John)
> - administrative access
Read "billing". Billing would be handled separately, as it is now.
> - data filtering, querying and searching
"Populations" of records are the interesting technical problem. I
suspect that patients should be allowed to "flag" sections of their
record that they wished to have available, in an anonymous fashion, for
population studies. In addition, the government, via the CDC, for
example, would "flag" certain portions of the record for their own
purposes, but once again the data would be stripped of identifying
data. As noted below, all this cries out for an XML record, which Brian
may have been suggesting.
> 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?
I'm glad you asked me that. It turns out that if you get 10
radiologists to interpret a chest x-ray you will get about 60%, maybe,
agreement on the interpretation. That's item one. Item two is that for
crucial image interpretation: mammograms, etc., to have to transmit the
image or store the image electronically (if it was not produced
electronically, in which case the discussion is moot) means that a
remote second opinion is being solicited. Whether that could be done
with "pointers" to the actual film which could be copied and mailed, or
whether it has to be done electronically is an economic question. In
any case, I don't think that many second opinions are made by
geographically separated physicians. Much of medicine is local (proven
again and again in practice variation studies). Finally, if one had a
web-based record, available anywhere (and the HL7 PRA initiative does
leap to mind here), one would have achieved so much that one could
tolerate not having 100%.
John Gage
