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<< start of forwarded material >> Date: Wed, 9 Oct 1996 07:45:42 +0100 To: [log in to unmask] From: Gerard Freriks <[log in to unmask]> Subject: Re: IBM's view of Internet-based medical records Cc: Bcc: X-Attachments: At 23:45 +0000 on 08-10-1996, John Farenden wrote: > On Tue, 08 Oct 1996 10:40:15 +0100, Ross Anderson wrote: > > >IBM's view on health care computing is: > > > >o Internet Health Care > > > > With an Internet-based health care system, patient records can be > > stored in a central location and accessed immediately by all properly > > authorized personnel required in the various processes. > > On Tue, 08 Oct 1996 10:59:02 GMT, Rob Tweed wrote: > > >Lets give them the benefit of the doubt - perhaps that's just their > >unfortunate wording. Each hospital's information system could be > >viewed as a "central" repository of the information they hold on > >patients they have treated. (ie small c not capital C) > > Agree - after all IBM have rather a large market in distributed > systems as well. > > >From that perspective, the total patient record is distributed across > >many healthcare "central" systems. The Web provides a basis for > >accessing and integrating such information, and their logic then > >sounds quite reasonable. > > > >I agree with you, however, that the idea of a Centralised patient > >record is barmy for a whole load of reasons - for a start it would be > >totally impractical and unmanageable, long before you get onto the > >security/ confidentiality implications. > > Srrikes me that the one "centralised" bit we do need to get to grips > with is a consistent method of knowing where elements of the > distributed records are located > > I know I could poll round every possible location asking if they have > part of a virtual patient record fragment but that would be rather > cumbersome. > > Alternatively a directory service. Nothing clinical - that's all held > under strict local control - but simply a single place holding > pointers to the known components of the virtual record fragments for > an individual. > > What I would need to be able to do is submit a request to the > directory service with some reasonably uniquely identifying attribute > of my patient (New NHS Number ?), and receive back a list of the > locations where record fragments for that individual are stored, as > long as I had permission to do even this. > > It's a bit like firing off a query into a specialised varient of a > search engine like Alta Vista using the unique patient identifier or > other attributes as my query term and getting back a list of URL's > pointing to the location of the known record fragments for that > individual. > > If my browser could then automatically make requests for the fragments > to retreive and construct my virtual medical record, then even better, > though the authentication protocols would need to come into play at > that stage > > Another feature would need to be that if a patient doesn't even want > it known that there is any information about them stored at location > X, then the local clinician at X simply doesn't tell the > directory/search engine. > > (I was thinking about a paradigm in which you didn't have intelligent > Web crawlers constructing the search engine index for you, but maybe > that's another idea - an automated electronic medical record reference > retriever - doesn't need to look inside the electronic envelope, just > crawls round the network, logging where the envelope is and > maintaining the directory automatically......) > > Clearly overlaying all this needs to be the framework of > confidentiality and the security measures to implement that framework, > but it's an exciting paradigm..... > He, he, Finaly I see others talking about a way of thinking about systems which, IMHO, will lead to a general solution of exchange of (medical) information in a secure, correct, flexible, etc, etc way. The prerequisite is an Information Infrastructure where Information can be found, secured, sent and retreived. An other part of the Infrastructure must be a 'Virtual (Patient) Record' so we all agree on the nomenclature of MetaInformation. E.g. we all use the correct Tags to indicate a Name or Diagnosis, the Coding system used. I happen to believe that the Dutch government might be in favor of the above. They see a possible way for the use of smart-cards where patients use it as a copy of the place-holders to systems where information about them is stored AND use it to control the access control lists. But.. things will work out only if a substantial effort has been put into the generation of the INformation Infrastructure. The hardware, software is there. What we need are the concepts, the vision. Greetings << end of forwarded material >> Gerard Freriks,huisarts, MD C. Sterrenburgstr 54 3151JG Hoek van Holland the Netherlands (31) 174-384296/ Fax: -386249 ARS LONGA, VITA BREVIS %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%