At 18:08 +0000 on 25-11-1996, Rob Tweed wrote:
> On Mon, 25 Nov 1996 18:48:01 GMT, you wrote:
>
> >The one problem I have with browser-type medical records is a simple one
> >of control of access to data. Right now GPs are the only people with that
> >access. Once the browser type record exists, that has gone.
>
> Not so - if you use the Web browser as a "dumb terminal" to access the
> record in situ at a remote site (remember the record fo a patient can
> be distributed across many sites/systems), then access control to the
> data is the responsibility of the organisation that captured the info
> in the first place - via an access control list. In fact, with a
> browser, potentially more control over who has right of access to
> patient information can be achieved - it's an application access
> control issue.
>
> Think "application" in this paradigm, not "Web page". The Web page is
> simply the format used to present the info to you when it's retrieved
> from the host system(s). Instead of wrapping up the output in, say,
> VT200 escape sequences to drive your VDU, the host application wraps
> up the output in HTML tags to drive your browser. How the data is
> stored on the host system is irrelevant. Use of Web technologies also
> means where the data is stored can be irrelevant to the user -
> provided they are authorised to use the host system.
>
> >I do not trust
> >the DoH that far, as they have been trying for some time to break the
> >dependency of individual patients on individual GPs - i.e. trying to
> >encourage a total free flow situation in which the lowest bidder can
> >provide primary care services.
> >
>
> The DH needn't come into it - control is with the organisation that
> captured the info, not via any central control.
>
> Of course the only thing needed for all this is an IP network - NHSnet
> will do, or of course PPP over dial-up PSTN/ISDN, or the Internet.....
>
>
Dear Fellow travelers,
Finally you are getting the message.
Make an other quantum leap. Don't make available a copy of the data
transformed into a HTML format for showing at a screen, but put the data
labelled with SGML on the line. And let the local program process it.
This gives much more flexibility.
Data stored on disks using SGML will be usable 'for ever'. No system,
application, application version, database model dependencies.
But substitute HTML and WEB-browser by SGML and the Browser + the Panorama
plug in.
And you are at the point where in the USA a HL7 technical workgroup will
start defining the EHR. (Hopefully compliant with the GEHR-terminology and
concepts)
In Holland chances are rising that the government will start using the same
lines of thought.
Problem: How to secure the flow and use of information? How to arrive at an
infrastructure for this?
Gerard Freriks,huisarts, MD
C. Sterrenburgstr 54
3151JG Hoek van Holland
the Netherlands Telephone: (+31) (0)174-384296/ Fax: -386249
Mobile : (+31) (0)6-54792800
ARS LONGA, VITA BREVIS
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