[LINK] Open source health records

Bernard Robertson-Dunn brd at iimetro.com.au
Tue Apr 28 19:36:20 AEST 2009

Stephen Wilson wrote:
> But if we're interested in analysing the 
> privacy of EHRs, then I think we first need to establish a model EHR, 
> and agree on a set of functions that we want to make happen.
When you look at a model EHR, that's when things start to get really 
messy. It sounds like a good idea, but thinking it through raises all 
sorts of issues - here's a few.

Suppose I have had a set of tests such as x-rays, MRI, fMRI, blood tests 
etc. These can go on my EHR, but are they still valid/current? I will 
have two sorts of hip X-rays - those before my hip replacement, and 
those after. Even with those after my hip replacement there are two 
sorts, those before an avulsion and those after.

Suppose there has been a mistake in putting the tests on my EHR, how do 
I get the mistake corrected? Tests are usually interpreted, suppose 
there is a mistake or disagreement amongst "experts"?

Will the EHR contain doctors notes and their opinions? All? Some?

Who owns the information on my EHR? Suppose the tests have been paid for 
by an insurance company - do those tests go on my EHR? Can the insurance 
company see my full EHR?

Who owns the EHR of a minor? Mother? Father? Suppose there is a divorce 
- who owns (or keeps) the EHR? Can step parents see the EHR of children 
of their partner? Who owns the EHR of someone over 16 but not yet 18?

What's the situation regarding husband and wife? Can the situation 
reflect religious preferences?

What happens if I go overseas? Can I take the EHR with me? Can I add to 
it from overseas?

Can I ask for information to be removed from my EHR? Suppose I have had 
an "embarrassing" (whatever that might mean - who says what embarrassing 
is?) condition. Can I request that details of the condition be removed? 

What's the situation of military personnel? There may be ancillary 
information that could be deemed to be of military importance such as 
where someone was tested and by whom.

And of course the big one - who can see the EHR? Can some of it be 
restricted? Under what conditions can the restrictions be relaxed? 
Emergency? Incapacity?

That's just a few that I can think of off my head. The health industry 
(or in reality, it's the illness industry) is the most complex I know 
of. Not surprisingly the information aspect is also complex. It is 
easier to muddle through than try and impose structure and process on 
it. Automation does not like exceptions - the health system is full of 
exceptions, so much so that the benefits of Information Systems are 
drastically eroded.

Just my $0.05


Bernard Robertson-Dunn
Canberra Australia
brd at iimetro.com.au

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