Hi David, How did I *know* I would hear from you on this subject? <vbg> (BTW: we still need to write that paper)
On Fri, 2004-10-22 at 10:12, David Forslund wrote: > I disagree. Your medical record can be created over a variety of locations > each of which may have its own id. This can occur even within a single hospital > system. Thus an MPI of some sort is required to "stitch" the medical record > together. > > Allow me to add a bit more context here. MPI's are required where you have disparate applications within a facility. I fully agree with those type of enterprise wide MPI's. It is very true that parts of my health record are created in various places. For example; my family doctor recommends I go see a cardiologist and she will send him a summary of the information he needs. My cardiologist (if I had one) does what cardiologists do and collects lots of data about my condition. At this point my family doctor doesn't need or want all that data. She wants a summary of my condition and the treatment plan. If for some reason she needs more information she knows where to get it. The same applies to hospital discharge summaries. This process / workflow remains the same irregardless the information transfer media. It is appropriate, certain and efficient. The federated approach means you have to be able to guarantee that I will have a unique identifier or trusted mapping between identifiers, between my family doctor and any number of potential specialists that I might be referred. Either of those two solutions is all the same just the latter has an extra layer for errors to creep into and the former is an impossible administrative task. The federated approach also means you must supply five nines or better connectivity. My recommended approach means I can send data and if it fails, retry later. There are still many many places in North America where you can't guarantee connectivity across town much less between towns. > > At any one point in time I have a unique patient identifier. Because my > > records are on file in Dr. Smith's office on Broadway in MyTown and the > > file number is 12345 I can have any pertinent information sent to my > > record. When I decide to switch to Dr. Jones on Main Street in > > AnotherTown I can do so and still have a unique patient (record) > > identifier.....just not the same one I had before. > > Exactly, but the records from both locations may need to be combined. Thus > the need for an MPI. No, they don't need to be combined. My original record can be moved/copied or not, as I choose and whether the applications provide a suitable means of import/export. The scenario above says I am changing PRIMARY care physicians....meaning there will still only be one primary care record. If a patient chooses to visit more than one primary (more than one 'primary'?) care physician at a time then they are controlling the quality of their medical record in a negative manner and simply should be advised as such. The potential still exists for one physician to send summary data to the other record if the patient wants. The technology exists to make large scale MPI implementations work. What doesn't exist are the social, administrative and financial capabilities. Regards, Tim
