On Wed, 26 Aug 1998 07:38:52 +0100, you wrote:
>In article <[log in to unmask]>, Mary Hawking
><[log in to unmask]> writes
>>
>I feel the EPR gives us more control over who can
>see what - so long as it is properly controlled and properly structured.
>
>I cannot write in invisible ink but I can protect electronic notes :-)
>
>Cheers
This goes to the heart of the matter - there are already lots of
perfectly secure electronic records in the business world which move
around the world and run vital services - eg: the global economy, air
and spacecraft design and travel, military communications etc.
The technology to ensure confidentiality of EPRs is current not
future.
The problem is that in any EPR system a balance between authority and
responsibility must exist, so that the individual with the
responsibility to the patient and his/her professional bodies must
have the authority to tag individual data items as sensitive and not
for the eyes of those not directly involved in patient care.
From the GP viewpoint, current NHS systems appear to separate the
responsibility for unwanted disclosures (firmly with the GP) from the
authority to control access (apparently in the hands of NHS managers).
Until authority and responsibility are seen to balance, a GP can never
be comfortable with an EPR or any NHS-run network.
Unfortunately our late 20th century civilisation seems to be hell-bent
on divorcing responsibility from authority.
(I note with sadness that the appearance of this cancerous
political/administrative process coincided with the decline and fall
of ancient Rome.)
Its simple really.
If a GP can really trust an EPR/Network combination he will use it.
If he can't trust it he won't.
The NHSE and the government are seen by many to be unworthy of trust
in this delicate matter.
My advice to the NHS is DROP IT! Hand clinical communications over to
clinicians who understand the subtleties involved and set up an
accountable body of clinicians who decide on difficult issues and
promote good usable system designs.
DIN was set up as a model version of such a system and it works.
KInd regards,
Paul
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