[LINK] Open source health records

[Stephen Wilson]

This is starting to look like a showy parlour game: Who can come up with 
the most problems in EHR?  So EHR is a hard problem.  A very very very 
hard problem.  So what?

How do you propose to advance?  Do you propose to advance at all?

Cheers,

Steve Wilson.



Bernard Robertson-Dunn wrote:
> 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? Restricted?
>
> 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
>
>