[LINK] Open source health records
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.
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