Tim Cook wrote:
In the real world though my medical record needs to be accessed fairlyyes, this is the main reason why I can't see any real use in the long run for EHRs on hand held devices. Even worse, you might take your EHRcard home with you, with the preliminary result of an investigation; the final result, or corrected result is generated by the lab but can't be sent to the EHR because it isn't online; so it is maybe never seen by you (how good is the synchronising function when you plug your stick in again? Where is the outstanding data stored prior to synchronisation?), and maybe not the next clinician who sees it (how can they have any confidence of how up to date your stick is?). And so on. Can't see it being a sensible solution.
often when I'm not there. One example is when lab test results come
back to the ordering physician. These results could sit and wait in an
electronic holding bin until I come back in with my record in hand but
they are relatively useless from a clinical standpoint without the
context of the complete (or significant parts) medical record. So if I
carry it around with me I may have to come in to see if the doctor needs
to see me again......There might be a workflow issue or two with this
scenario. <g>
Other reasons...
* they will get lost.
* no-one can do decision support on your data while your EHRcard isn't in a computer somewhere. This limits decision support to those times when the EHRcard is with you, in a doctor's room. Not much use for e.g. medication review being conducted overnight on 1000s of patients
* no-one can do population queries on your EHR, or if they do, it has to be while it is installed in a machine at point of care, in which case secondary use of the EHR is interfering with primary use of it.
The second two items might be ameliorated by consumers having their EHRcard always plugged into the back of their own PC at home, which is itself always available on the local healthnet VPN...but then you might as well just have it on the server side and get the benefit of homogeneous security and data management...home PCs won't in general get close to the quality of data management at a well managed server site. And you still have a problem when your PC is off-air. What if it turns out that you have a notifiable disease, but the test result that says so is stuck inside some cache at a pathology laboratory for weeks, while your EHRcard sits inside the glovebox of your car next to your old cassettes?
I would think any of these problems would realistically kill stone-dead the use of hand-held EHRs...but who am I to question the market?-)
- thomas beale
