On Tue, 08 Oct 1996 10:40:15 +0100, Ross Anderson wrote:
>IBM's view on health care computing is:
>
>o Internet Health Care
>
> With an Internet-based health care system, patient records can be
> stored in a central location and accessed immediately by all properly
> authorized personnel required in the various processes.
On Tue, 08 Oct 1996 10:59:02 GMT, Rob Tweed wrote:
>Lets give them the benefit of the doubt - perhaps that's just their
>unfortunate wording. Each hospital's information system could be
>viewed as a "central" repository of the information they hold on
>patients they have treated. (ie small c not capital C)
Agree - after all IBM have rather a large market in distributed
systems as well.
>From that perspective, the total patient record is distributed across
>many healthcare "central" systems. The Web provides a basis for
>accessing and integrating such information, and their logic then
>sounds quite reasonable.
>
>I agree with you, however, that the idea of a Centralised patient
>record is barmy for a whole load of reasons - for a start it would be
>totally impractical and unmanageable, long before you get onto the
>security/ confidentiality implications.
Srrikes me that the one "centralised" bit we do need to get to grips
with is a consistent method of knowing where elements of the
distributed records are located
I know I could poll round every possible location asking if they have
part of a virtual patient record fragment but that would be rather
cumbersome.
Alternatively a directory service. Nothing clinical - that's all held
under strict local control - but simply a single place holding
pointers to the known components of the virtual record fragments for
an individual.
What I would need to be able to do is submit a request to the
directory service with some reasonably uniquely identifying attribute
of my patient (New NHS Number ?), and receive back a list of the
locations where record fragments for that individual are stored, as
long as I had permission to do even this.
It's a bit like firing off a query into a specialised varient of a
search engine like Alta Vista using the unique patient identifier or
other attributes as my query term and getting back a list of URL's
pointing to the location of the known record fragments for that
individual.
If my browser could then automatically make requests for the fragments
to retreive and construct my virtual medical record, then even better,
though the authentication protocols would need to come into play at
that stage
Another feature would need to be that if a patient doesn't even want
it known that there is any information about them stored at location
X, then the local clinician at X simply doesn't tell the
directory/search engine.
(I was thinking about a paradigm in which you didn't have intelligent
Web crawlers constructing the search engine index for you, but maybe
that's another idea - an automated electronic medical record reference
retriever - doesn't need to look inside the electronic envelope, just
crawls round the network, logging where the envelope is and
maintaining the directory automatically......)
Clearly overlaying all this needs to be the framework of
confidentiality and the security measures to implement that framework,
but it's an exciting paradigm.....
___________________________________________________________________________
John Farenden - Secta / Health Web Services
Triton House, Hare Park Lane, Liversedge, West Yorkshire, England, WF15 8HN
Tel 01274 852160, Fax 01274 852159
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