[LINK] Open source health records

Stephen Wilson swilson at lockstep.com.au
Mon Apr 27 08:48:44 AEST 2009

Lea de Groot wrote:
> I've always wondered why spending a fortune on computerising medical  
> records will be so good, myself.
The case for EHRs is a hotpot of intuition, epidemiology, public health 
policy, and hyperbole. 

The claimed outcomes range from tens of thousands of lives saved, to 
tens of billions of dollars saved.  Some the pro-EHR arguments are 
flimsy, while some are reasonable (and falsifiable) but as yet not well 
tested.  In these days of the sound bite, too many of the arguments in 
my view are based on easily digested little what-ifs.  For example, If I 
am hit by a car and taken to hospital, wouldn't it be good if the ambos 
and ER physicians could access my medication records?  Or, When I am in 
hospital, wouldn't it be good if each and every attending doctor didn't 
have to take my history all over again.  But talk to doctors and they'll 
often say they prefer to take their own history, because they're often 
looking for different things than were the preceding carers, so this 
particular what-if is tenuous.

Amongst the most robust arguments in favour of comprehensive EHRs are 
the following ideas:

- Population-wide longitudinal health records (de-identified of course) 
will be a crucial resource to underpin evidence-based medicine, better 
health policy, better public health monitoring, and more targeted 
expenditure in government health programs, like the PBS. 

- Better access to test results (x-rays, pathology etc.) means less 
repeat testing and less cost.

- Better access to data from hospital stays (e.g. by GPs seeing their 
patients soon after hospital discharge) means better follow-up therapy, 
better outcomes, fewer repeat tests, less hospital re-admissions, less 
cost, and better allocation of scarce hospital resources.

Some of the seemingly worthy but maybe untested ideas revolve around 
patient-centred care and patient-managed health maintenance.  Basically, 
if patients have more involvement in their own healthcare, aided by 
online Personal Health Records (PHRs), then it is thought that they will 
turn out healthier.  Seems reasonable, but on a population-wide basis, I 
am not sure if the idea is scalable and therefore beneficial across the 
board.  Nevertheless, really big employee PHRs are rolling out in the 
USA (at Walmart for instance) where they might have a special place in 
their weird and wonderful Health Maintenance Organisation (private 
insurance) managed care model.


Stephen Wilson.

Lockstep Group
Lockstep Consulting provides independent specialist advice
and analysis on digital identity, privacy and cyber security. 
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