On 28 Nov 96 06:42:41 EST, Mike Turner wrote:
>Gerard,
>
>With respect to your comment "Partial records are no problem", I would be
>interested to know how the client knows where the fragments of the patient
>record are located?
>
>I can see a client could be very useful to provide a common view of the patient
>record from disparate systems within a hospital environment but how,
>practically, would the client know what locations to obtain information from in
>a general practice scenario where information is potentially scattered across
>the Web. Do you anticipate that an index of URL's would be held, or that each
>organisation involved in the direct or indirect care of the patient would run
>some sort of Web crawler programme to periodically update existing references
>and look for new ones ?
In England and Wales an adaptation of the NHS Administrative Register
(for Scotland and Northern Ireland read Community Health Index) could
be seen as delivering just this - it holds no clinical information,
but merely acts as a hub indicating the locations of fragments of the
distributed record, each fragment of which is held in a secure
envelope, access into which is only permitted to those with an
appropriate key.
.. if one imagines it as an Alta Vista lookalike, but offering an
end-user a service to use an identifier rather than free text as the
key to pull back a set of "URL's" indicating the locations of the
envelopes containing the record fragments -
..and of course the webcrawler model is interesting - a form of
electronic medical records manager which just seeks and indexes out
the locations of secure "envelopes" of record fragments
Quite apart from performance issues, it would have to be capable of
supporting such security mechanisms as would be needed to implement
confidentiality principles - a patient may not wish to have it
generally known that even a secure envelope containing a record
fragment exists in a particular organisation - but IMO the technology
is unlikely to be the barrier. Getting the principles right is key.
..but then implementation of such a model relies on a consistent
framework of standards a la the Web (but not necessarily big central
solutions :-)
Ah well.....
John Farenden
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