As the paradigm of a distributed system with data access over a network
becomes more accepted there are two ways we could go with the actual
notes - by which I mean the narrative and such detail as treatment
histories and physiological measurements.
One is to centralise all records onto a big server in Whitehall, or
individual ones for each HA (an idea recently de-emphasised by
Somerset, following discussion with the profession) or more acceptably
onto individual servers for each PCG.
Another is to accept that the benefits of consistent access to records
across a practice; PCG; HA or nation (or indeed Economic Community or
species) are real and can be provided better by networking and the
application of standardised query languages and data description such
as HQL, MIQUEST, HL7 and XML,
but
that the benefits of confidentiality, control of access, reliability of
availability of records at the point of care could be diminished by the
use of any credible centralised storage solution. For instance if the
mechanisms for retrieving and recording information in the consultation
were as quick and reliable as the NHS Net e-mail enjoyed in Devon, we
could all go back to paper - more generally, the record of availability
of HA computer systems is too poor for a mission and time critical
system, and there is no clear indication of funding or political will
to change this.
Therefore it is worth considering solutions which go furhter than the
idea of leaving all information about the patients of a particular
practice on the practice's server, toward solutions which store the
records of an individual doctor's patients on that individual doctor's
machine.
Peer networks permit these records to be accessed within the practice
whenever it is proper and needful to do so, and server technologies may
well be used for backing up such records, indeed one might implememnt
it by using a share on the server to hold the records rather than
physically placing them on the doctors' own machines. Or one might not.
Such an approach fits in well with the storage of a patient's records
as a single marked up file, with links for certain items stored
elsewhere, and it fits in with the movable patient record we demand,
and with the evolution I see for legacy systems into medical record
engines - which on demand for a note on a particular pateint would
deliver this, in a standardised format, for use by whichever client had
demanded it.
Interesting times.
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