[LINK] Open source health records

stephen at melbpc.org.au stephen at melbpc.org.au
Tue Apr 28 00:15:13 AEST 2009

Thanks Stephen and Marg for your macro level perspectives re this ..

>From a ground perspective, one understands that proprietry health record
apps in the States cost around $20k per service provider, and hence many
small practices are naturally resisting purchase. For a one / two doctor 
practice, that's quite an investment. Open source apps should be a bonus.

Here in Australia, when one patient wants to transfer doctors, the usual
method is to pester your doc for your records, and eventually, they send
them on. (In my case a one page handwritten note, sent by snail mail two
months or so after asking). 

If the Americans come up with appropriate open source apps, then perhaps
several developers here might come up with a local version, in maybe two 
months or so? Maybe we could simply utilize appropriate and secure web 2
technology on an appropriate gov website. Either way, such systems would
surely offer an intelligent improvement over existing methods here, imho.

Simple, cheap, reliable & effective. With patient permission requirement
for access, one's medical records would also be safe & relatively secure
from fire, theft and inadequate back-up etc etc. And from my experiences
as a practicing psychologist (in another life) such records can be vital.

Whatever, it seems quite certain that an e-health systems will naturally 
evolve eventually .. and it seems to me that sooner is better than later
as long as such systems are robust, safe, and, above all, non-proprietry.

I wish the Americans well with their efforts, and hope we may learn from
their public health experiences in this regard, if not in other respects
for effective, ubiquitious and cost-effective public health provisioning. 


> 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 
> 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 
> 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.  
> if patients have more involvement in their own healthcare, aided by 
> online Personal Health Records (PHRs), then it is thought that they 
> turn out healthier.  Seems reasonable, but on a population-wide basis, 
> 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.
> Cheers,
> Stephen Wilson.
> Lockstep Group
> www.lockstep.com.au
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