|
Security and Confidentiality, Permissions
Ross Anderson and the BMA are working hard on this. My thoughts include the effect on disclosure to lawyers, insurance companies and Courts of having lines in the record marked as private from the person doing the disclosure.
The Hospital End
Of course part of exchanging records must be the hospitals. As a general principle, before computerising a system, sort out the previous paper or whatever based system, otherwise one risks doing an IoS-Links like job. A paper I wrote a while back on how to write discharge summaries as an SHO, for GPs. The key thing is that the process starts before the patient is admitted.
Exchanging Patient Records
One of the more striking features of the paper stuffed Lloyd George envelope is that it is in fact a patient record which can be sent from one GP to another. Cursory thought about this makes people think this means it has passed from one record system to another, but in fact transferring structured information from one paper record system to another is very labour intensive and prone to errors.
For this and other reasons the actual users of GP computer systems, the GPs, have a high level of frustration with the failure of suppliers to get a common interchange standard working. The task is significant, but not unduly difficult.
Accreditation
Many organisations would like to accredit GP systems. Do they offer anything but an assurance that GPs are paying for a system that does what the accrediter needs (provides secure employment, moves boring typing away from their office, produces statistics)
Is RFA useful?
What do I want my clinical system to do for me?
What are the roles of computers in General Practice?
- To make the notes legible, duplicable (send to next GP but retain complete
record (very useful for Linked Practices who suffer random spurious patient deductions); view at reception, nurse's room and in Dr's room simultaneously, visible as a
cross-section of of the Practice population rather than by individual patients, visible as a
sequence of encounters or events in time regardless of patient ID or operator.
- Organisation of notes so as to display different views of information entered only once.
- Family history
- Drug and treatment information coming from inside and outside the Practice
- To automate the financially important tasks of claiming for eg
contraceptive services; immunisations; Notifications of disease; PMA reports, by
making the production of and accounting for claims a default consequence of
doing the clinical work.
- To co-exist in harmony with other programs available at the same time to the
same users (synonym is 'run under Windows') and to co-operate in the processing of
data by third party programs on the host system for the individual user's
purposes.
- To allow the rapid production of management information directly from the
clinical data in the clinical system (eg total consulting time required
broken down by week of year and by day of week for the years since the system started up,
and by type of encounter, person etc)
- To identify financially as well as clinically significant tasks which should be considered either with reference to the patient whose notes are being acted on, or in aggregated or global reports (if some financially sensible tasks are not high in clinical priority, this is an indication to revise the financial basis of General Practice, not the computer programs, and to do so fast).
- .
- .
- .
It is unlikely that a system will satisfy all these on its own, and the one
I use requires a degree of assistance from Access and VB to do it all.
If a system is based on an "open systems" aproach then users can readily seek such assistance, but if the organisation producing the system is successful in keeping it proprietary then users remain dependent upon them.
This may seem unimportant at first, but one cannot predict the future development of for instance a company marketing a product they have written to run under particular operating conditions.
Among the less obvious ways of undermining openness are legitimate programming techniques such as adding an index dependent on a function which is concealed or proprietary. This stops amendment or in some cases even reading of a data file by other programs.
What is an Open System?
|