Re: OT: EHR, etc.

David J Dachtera wrote:
Well, the Electronic Health Record is not a "cure all", and cannot address the
issues you cite unless the staff accompanies the patient to his new unit - which
doesn't happen.

Perhaps this is an issue IT cannot solve yet, but it is very important to health care. If a guy has a broken leg, it doesn't matter. But if a person's mental alertness is affected by the problem (such as urinary infection for elderly people), knowing about periods of mental alertness while at ER, as well as transfering the knowledge that came from the family on the metal status of the patient prior to that incident is very important to all the staff in the new ward to gauge the patient's current status relative to the other experiences so far.

The Electronic Health Record adresses that concern, but also raises concern
about protecting the patient's privacy. Hence access controls are emplaced.

It seems to me that a lot of those thing are designed by people very detached from actual emergency rooms (large consulting forms with big fat contracts to generate books of documentation) as opposed to designers who really know what should be done at the ground level.

At some point, the Electronic Health Record may evolve to that level. We're
already seeing some of this in the private sector. Wider acceptance will be
subject to all the usual flap over HIPAA and information security beyond HIPAA.

Well, once a patient check in, he/family should provide the OK to access his/her records from another health care facility. Seems to me that this should be automatic because in the end, doctors in the ER cannot really make an good diagnostic if they do not have a patient's proper history.


Realistically, the back-end servers ("tier 3" or "tier 2") really are
transparent to the end user. The "user interface" ("tier 1") will be the issue.
Obviously WhineBloze is not acceptable, yet it is ubiquitous.

However, when you consider province wide systems like in Canada, the provincial government is the one that signs the big IT contracts to develop systems for hospitals. And they they to make "popular" decisions instead of selecting obscure systems because they are better. I underline OBSCURE here because this is what VMS is. In the case of Québec, it is even worse because they really got burned by Compaq: they signed a huge contract for Alpha servers deployers throughout the province in February only to find Compaq announcing the end of Alpha on the following June 25 a few months later.


Could we convince the industry to go with some other access model? Perhaps an
x-based thin client invoking software on a secured "middle tier" server
(instances, blade, etc.) (Gnome/KDE on *BSD, DECwindows on VMS, Gnome/KDE/X on
AIX or Solaris, etc.)

I agree. However, in the case of a province-wide system, should records be distributed, but accessible from any centre/hospital, or should there be one large central database that is fully redundant and available 7/24/365 no matter what. (this would generate some heated discussions about privacy).


Anyhow, I have thought about you (since you are the health care guy on COV) lately because I noticed a case where the hospital's system could really be improved.
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Relevant Pages

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