In article <[log in to unmask]>, Adrian
Midgley <[log in to unmask]> writes
>But then, as you know, I am inclined toward keeping records in one (or
>a few) file per patient., and still waiting for somebody to show what a
>silly idea that is.
>ASCII seems likely to endure for a generation, and after that it is
>somebody else's problem. DOS UNIX Windows and the MacOS seem to be
>able to read each other's files, so I don't think an OS is required to
>be on the archive.
Taking all the previous points into consideration, I have a suggestion.
Some points are my own, others made elsewhere. It assumes computers are
here to stay in GP and that their technological improvement continues.
What we need is a complete change of model rather than a piecemeal
kluge.
1. Replace paper notes with smart cards.
Personal. Always available with patient. Full dataset.
2. Readers:
a. Surgery reader - keeps full copy of card dataset while
patient registered. Relinquished when patient leaves.
b. Portable reader - visits and out of hours. Only keeps
a copy of relevant episode.
c. 2nd database - keeps parallel copy of epidemiologically
defined factors. Only accessible for statistical data.
Its use is transparent to the user. ? electronically
linked to central database. ?like PACT.
d. Portable reader updates surgery reader when docked.
e. Hospital reader. Updates surgery reader electronically.
f. DN, HV and PN readers - uses subset. Updates surgery
reader.
g. Automatic daily backup of datasets, possibly at regional
as well (?PCG level at present - who knows next year).
3. Pharmacy reader.
Only reads Rx and allergies. Connects to central database.
Prescription records available to surgery reader as update.
Also has 2ndry epideniological db and connects centrally.
4. Requirements.
a. Transfer of old notes to computer. Paid per byte count.
Can be done by any doctor at home or elsewhere.
b. Initial high investment. Electronic future compatible.
c. Single nationwide format.
d. All software and hardware provided free by Gov. they
already do with paper notes. Security then Gov's
responsibility.
e. 3-5 year plan. Funded with new money. Sell a Trident
sub?
f. STOP all paper notes at end of 5 years. Fund extra work
until changeover complete.
g. All cards numerically identifiable - same security as
bank cards. If lost then can be replaced at cost - old
numbers invalidated.
h. Fast electronic links (ISDN at present - ?satellite)
All of this is technically feasible and circumvents many identified
problems.
Regards
George
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