Some simple thoughts from Holland.

Persons must be held responsable for the storage of information, the
release of information, the access to information.
Each 'Functional Unit' (1 GP, 1 group of co-operating GP's, one
depeartment, one hospital) will be responsable and the largest unit at
which information is kept.

So NO large distributed systems.
No automated access to systems outside the ' Functional Unit'

INformation about patients is very sensitive.
So medical information must be kept separate from identifying information
(Name, addres, birthday, etc)
Regional or local  servers will provide the link of this information which
identifies the patients to localy unique secure patient numbers used to
access the medical information.
National or regional servers will record the sites atwhich information is kept.

Each Server will have the capability to let patients control access-rights.


At 14:14 +0200 01-08-1998, Adrian Midgley wrote:
>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.


ProRec- Nederland
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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