[log in to unmask],Net writes:
>From: Katie Law <[log in to unmask]>
>Subject: Re: Distributing and controlling medical records
>Date: Mon, 3 Aug 1998 19:09:23 +0100
>Perhaps because that voice is expressing things well?
Ooh Katie, a gold stamped cyberhug.
>Also it has touched on so many different aspects it is difficult to
>maintain continuity - maybe separating out some of the arguments would
>help?
OK. Let me separate out the original argument, again, that being the
point I posted on, and presumably, since David is attacking me, the
point of contention? I think not.
Developments in networking and systems offer us the option of placing
the records of a particular doctor's patients under the sole physical
as well as logical control of that doctor, by storing them actually on
their desk.
This offers certan advantages in confidentiality (Confidentiality being
A Good Thing like motherhood, applepie and the British Constitution)
over alternative approaches which are presented to us which would
involve centralising records on a server for a Practice (the usual
arrangement, as is a row of shelves per practice for most of one's
patients' paper notes, cf the bottom drawer ofthe desk for the _really_
confidential ones), or one server per group of practices or PCG, or one
server per HA which is an approach Somerset HA thought well of until
dissuaded by among others myself at a recent meeting of enthusiasts (IE
the IT Wallah* enthusiasts actually gained a point for patient
confidentiality)
I am in favour of such decentralisation, rather than what an NHS
politico-administrative complex driven to demonstrate (by vociferous
and sceptical tax-payers) that they are obtaining good value from NHS
spending, and that they are able to plan and actually are planning
provision according to demand, incidence, prevelance and morbidity of
various conditions. The latter being a system which compels every
health outlet to run an additional task of completing forms detailing
what they are doing, to whom and so on, to be aggregated by teams of
adminstrators and clerks centrally, and enforced by finacial and
statutory incentives and penalties overseen by yet more hordes of
admindroid, each of whom will claim the right to see every detail of
every clinical note, to check the coding and claims.
Certain developments in systems available to GPs will allow the
modelling of ht porcess by which occasionally a professional colleague
contacts us to say that they have a patient of ours, unable to give a
detail thy regard as important to provide the best care for our
patinet, and we give it to them after suitable checks to assure us of
their bona fides
"Q: are you a member of the NHS family? A: Yes". or maybe there is a
different
challenge authetication protocol in use. Still <g>
And, here is the clever bit, modelling it so we can be asleep and it
still happen. However, if one prfers never ever to give any info out,
fine, switch it off.
People looking after my patients can ring me at home, and sometimes do,
and it would be a pity to lose that. But - sometimes I go out without
my mobile phone.
The alternatives to networked enquiries such as MIQUEST and CHDGP (and
anyone replying without reading the website at
www.nottingham.ac.uk/chdgp can reasonably expect to be savaged by me if
not by that nice mild lady Sheila Teasdale) which protect patient
confidentiality while providing the information needed to run the NHS a
little better than it is run at present are:-
face down the Government, explaining to them that it is improper for
them to
obtain information from GPs in order to givern. <ROTFL>
allow the gov to set up systmes they contro in order to do what they
feel they
need to (in the expectation that those systems will be less GP
friendly than ones
we design or commission ourselves, and more expensive, thus removing
money
from the pool of total spending which could otherwise be obtained by
our clever
representatives and routed to us
er.... I think thats it, unless someone can come up with another one?
So, I move we network the NHS using a modular approach practice by
practice, PCG by PCG and HA by HA, with concentric layers of security
and reliability.
The sum total of it all can be called the Internet, or the NHS Net, or
whatever anyone likes, and they can draw their lines in the clouds**
according to taste, but one operating principle is that most of the
time my messages and info will need to fly around Exeter, but rarely
around the NHS Net Syntegra BT spine, and therefore I want a hub in
Exeter.
And I move we keep it under professional control.
------------
* Etymological note: Wallah was imported from the Raj, the Indian Army
of the Imperium, and means "man". eg Punkah Wallah man pulling punka,
or string.
** every diagram of the Internet or the NHS Net seems to include a
cloud. Odd that once into the cloud you run into a mass of detailed
regulation with NHS Net, whereas the internet just has a rule or two.
And it works hahahahaha.
>--
>Katie
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