>From: PTBromley <[log in to unmask]>
> Apparently he's testing portable EMIS on a Psion.
>  >>
>Actually I think you are wrong here - they download the whole practice
>database onto a 4 megabyte Psion 3a, and split this file in a
commercial
>database. The download consists of a set of patient details BPs,
medication,
>last couple of consults etc. He gave a presentation at the '96 EMIS NUG
>Conference. They use it as a 'Read Only' databse - for info on-call,
and make
>no effort to write inofrmation back to the EMIS database. 

Interesting.
And rather begs the question of why one wants to lug MUMPS around 
with one, and therefore become stuck with a machine which runs it.

View the medical record as composed of a series of individual notes, 
almost always falling one upon the previous one.

An alteration to an existing note is exceedingly rare, when it 
occurs is usually an addition to the fixed text previously existing 
(eg "no, shown not to be") and in any case one wishes to retain and 
display conflicting versions (example: letter from 
gastroenterologist: "his chest pain is angina not GI"; letter from 
Cardiologist: "his chest pain is not angina and must be GI" - we do 
not permit one of them to overwrite the other, we merely exercise 
our finely honed intellects to accomodate the different opinions) 

Therefore one need not update a portable copy of the records.
One need not carry it in a database, since it is unusual to stop in 
the middle of a round, even while the Archers is on, and commence a 
search of the practice to determine how many people are prescribed 
Omeprazole... or even how many have had their cholesterol measured.
These are tasks for the base machine and data warehouse.

So, in the portable one needs a copy of the record of the individual 
patient one is addressing - which may as well be a text or at worst 
html file, without consistency checking, signatures, audit trail or 
other massive addenda - 
and a means to generate a message - the electronic equivalent of one 
of those Winthrop labels.
The message should be efficiently identified as to who made it, when 
where and so-on, and should carry a checksum or hash to demonstrate 
it had arrived undamaged, but is basically only a message.

Given that this simple and cheap approach is effective for rounds, 
and out of hours, does one need anything more complex on the 
consulting room desktop?  I think not.



--- OffRoad 1.9r registered to Adrian Midgley


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