<< start of forwarded material >>


Date: Wed, 9 Oct 1996 07:45:42 +0100
To: [log in to unmask]
From: Gerard Freriks <[log in to unmask]>
Subject: Re: IBM's view of Internet-based medical records
Cc:
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At 23:45 +0000 on 08-10-1996, John Farenden wrote:


> 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.....
>


He, he,


Finaly I see others talking about a way of thinking about systems which,
IMHO, will lead to a general solution of exchange of (medical) information
in a secure, correct, flexible, etc, etc way.

The prerequisite is an Information Infrastructure where Information can be
found, secured, sent and retreived. An other part of the Infrastructure
must be a 'Virtual (Patient) Record' so we all agree on the nomenclature of
MetaInformation. E.g. we all use the correct Tags to indicate a Name or
Diagnosis, the Coding system used.

I happen to believe that the Dutch government might be in favor of the above.
They see a possible way for the use of smart-cards where patients use it as
a copy of the place-holders to systems where information about them is
stored AND use it to control the access control lists.

But..
things will work out only if a substantial effort has been put into the
generation of the INformation Infrastructure.
The hardware, software is there. What we need are the concepts, the vision.

Greetings


<< end of forwarded material >>

Gerard Freriks,huisarts, MD
C. Sterrenburgstr 54
3151JG Hoek van Holland
the Netherlands  (31) 174-384296/ Fax: -386249

ARS LONGA, VITA BREVIS




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