[log in to unmask],Net wrote at 15:51 on 03/10/98 
about "Re: missing records and information management":
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>MIdge said:
<as usual, quite a lot, most of it snipped>

>>It is no longer acceptable that OoH centres do not provide access to
>>the notes, IMHO.
>
>
>I know I shouldn't _really_ say this to Midge but how practically
could one
>do this in the _near future_ given that it is no longer acceptable not
to
>provide access to the notes OOH? A typical Co-op covers say 100 docs/30
>practices 
Yep, here it is 84 GPs, of whom about 60 are in the Exeter PCG area 
and the rest are in two other neighbouring areas.
>and usually one would be looking at several different clinical DBs
>not to say differing, even archaic, operating systems. 
Yep, several on BOS and even more on MUMPS
>These practices would
>have to link up to the Co-op that probably runs its own brand of
clinical or
>callogging DB. 
No.  I don't think so.
method 1: AFAIK all the suppliers at least claim to be able to 
provide a branch surgery facility.  For the terminal-based systems 
the bandwidth required to run a terminal is about 2k, for the 
flasher smarter ones using thin clients it is about 5k, one would 
like a peak of 30-56k for a web front end on an intranet solution 
set up with a server and browser.
Use whatever they have produced so far, and each practice has a 
branch at the OoH centre, each dctor has a user ID on each system, 
as a mior side effect we all become familiar with each other's 
clinical software leading to registrars and assistants and even 
principals finding it easier to work in each other's surgeries.

The best software will of course demonstrate its qualities to 
everyone in the co-op/PCG, and therefore will be spontaneously 
adopted by all of them, so the suppliers will all co-operate if they 
think they can claim to have the best software, and if they are 
difficult about it we will all know they don't think their software 
is best. 

method 2:  use an intranet-server to pass html pages to the browser 
at the OoH centre.
THis requires a separate layer of software which we need anyway, 
which interrogates the existing legacy systems and passes either 
text, structured files, or html to other programs.
THese are not difficult to write, it is likely that all serious 
suppliers have made some steps toward it already, as any programmer 
is likely to be thinking about this sort of thing and wanting to 
play, and there are several specialist solutions written or being 
written.
As it happens, I know what I am talking about here, because I have 
written one myself, using the free Windows version of httpd the 
widely used Unix web server, and Visual Basic as a cgi interpreter.
A second way of accomplishing this end, rather than by dialup and 
interrogation in real time is to run a process from time to time 
which produces a defined summary or subset of each patient's record, 
and stores this in a directory on a hard disc in a machine to which 
there are access rights over the network suitable for these 
purposes.

What network you ask?
Something called NHS Net is one possibility, but basically one 
assumes that a PCG will have a network, and the actual technical 
solutions and indeed the location of storage are of no technical 
complexity nowadays - although there is considerable political, 
managerial and ethical complexity as well as the legal minefield we 
currently operate in by not having access with the patient's 
permission.
Only thing is, looking at the stuff I have on NHS Net thus far, I 
don't see the detail on connecting OoH centres or Co-op networks to 
the NHS Net.  Needs urgent attention by NHSE/IMG I think.

>I know some Co-op systems are trialling linking with Emis but
>all the systems?? Nightmare.
You may be misunderstanding linking here.  AFAIK the link is to push 
info into EMIS, rather than to pull it out, but perhaps EMIS are 
already working on this..If so they are probably using the M-Connect 
technology, as could the Exeter System people, to connect an M 
database to an ODBC driver so as to allow any ODBC compliant 
programming environment (eg Visual Basic, Visual C++, Access,.Delphi 
etc) to interrogate the legacy format data tables.
Alternatively, there are other kludgier solutions involving a 
pretend terminal, and these appear to have been applied to Vamp 
Medical.  The Exeter System and EMIS of course already have their 
terminal emulators runing in Windows, the former based around the 
PDQComm.vbx and the latter apparently homemade.  Minor extensions to 
these if they have not already been made would allow an interface to 
other programs.  I have no details about the ICE10 and other Unix 
terminal emulators used by AMC and MicroTest sites, and am unsure 
what technology is used for System 5 branches on Windows machines, 
but I doubt there is a problem with it.

It would be nice to make the link two way, but by no means essential, 
the _requirement_  is to be able to read the notes and a simple 
e-mail back over the system would be a perfectly reasonable way of 
running the up-channel.  The existing bespoke solutions "branch 
surgery" of course do give the two way link, and have really only 
waited on networking and recognition of the need to be implemented.

THe details of running a network in the OoH centre which has at least 
two programs  running on it, and connections to at least two other 
networks, are left as an elementary exercise for the student.

>So unless we *impose* a clinical DB on *all* the GPs NOW and thereby
link
>with just one DB how would you propose this to be done??

As above.  No imposition.  So, are you sorry you asked?
--- OffRoad 1.9r registered to Adrian Midgley


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