On Tue, 2003-06-10 at 04:42, Tim Cook wrote: > On Mon, 2003-06-09 at 03:58, Thomas Beale wrote: > ... > > kind of "co-pilot" for the patient. THe paradox is that the GP may be > > helping to make some of the most important decisions for the patient, > > even if it is just deciding when they should see a certain kind of > > specialist or when their lifestyle _really_ needs attention etc - but - > ... > > any thoughts on this? > > If not already obvious......from my perspective the GP is the only > logical EHR manager. Well, actually at the practice level.
Yes, but that doesn't necessarily mean that the actual hosting of the EHR datastore needs to be done in the GP's office. Where communications infrastructure makes it possible, it makes a lot of sense to co-located all these practice EHRs in one place (or even as Linux partitions on one large IBM mainframe), and reap large economies of scale in terms of physical security, backups and disaster recovery and accessibility. Such a model also makes a more federated architecture possible. But physical co-location doesn't overcome the need for logical interoperability. > > This may also be a community clinic in the US as there are many people > who do not have a family physician. And many people change their GP every few years - my family has, every time we move house. Frequency of change of residence is directly proportional to socioeconomic status (at least it is here in Australia) - poor people move more often, and these are the people who would benefit most from a thorough longitudinal view of their health status and problems. After you consider this, the idea of a third party EHR manager, which maintains the patient's record on their behalf, starts to seem desirable. However, such an EHR manager would need to be completely impartial and have not interest in hindering EHR portability, which means that funding would need to be carefully thought through. Tim C > > --twc > > -- Tim C PGP/GnuPG Key 1024D/EAF993D0 available from keyservers everywhere or at http://members.optushome.com.au/tchur/pubkey.asc Key fingerprint = 8C22 BF76 33BA B3B5 1D5B EB37 7891 46A9 EAF9 93D0
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