[LINK] US: Electronic Health Records

[Roger Clarke]

At 16:30 -0800 14/2/10, Scott Howard wrote:
>Despite the very real issues that exist with electronic medical
>records, it's very hard to argue that there are massive benefits as
>well.

It's very *easy* to argue that there are *not* massive benefits.

Agreed:  there's a bunch of *good* reasons to use IT to support data 
capture, storage, use, and transmission to health care professionals 
who have good reasons to want access to it.

But the eHealth push is driven by IT providers, bureaucrats, insurers 
and researchers.  It is not driven by health care professionals, 
still less by patients.

Health care is by its nature a very large sector, it has for a very 
long time comprised large numbers of specialisations, and the 
specialisation is increasing not decreasing.

Data arises in a very large archipelago of islands.

The (usually implicit) assumptions that all data has to be 
centralised, or at least virtually centralised, and that all data 
about an individual has to be associated with a single unique 
identifier, are completely unjustified, and unjustifiable.

Firstly, health care professionals don't want access to all health 
care data, nor even need it;  and their position is entirely logical. 
(That needs a moderately lengthy discussion, but not right now).

Secondly, the presence of large volumes of data gets in the way of 
health care;  it doesn't improve it.

Thirdly, many circumstances arise in which people want to keep 
segments of their health care data separate from one another.  (There 
are many sensitivities and bigotries, and there always have been, and 
there always will be).

Fourthly, economies of scale and scope have well-and-truly ceased to 
exist, even within large hospitals, let alone across complete health 
systems.

Fifthly, diseconomies of scale and scope have well-and-truly set in, 
even within large hospitals, let alone across complete health 
systems.  (Put another way, the layers of managers that get inserted 
in order to cope with span of control limits, and the time spent on 
coordination, and the sheer complexity of it all, make managing any 
moderately large health care facility an absolute nightmare for all 
concerned).

What we need is a federated approach, not a centralist approach.

We need inter-operability measures, in the sense of IT protocols and 
standards, and common vocabularies and thesauri, but also in the 
sense of human and organisational protocols to enable negotiations to 
take place.  We also need consent processes and means of supporting 
them, in order to avoid patients feeling that they need to obscure 
information.

See:
http://www.rogerclarke.com/EC/eHlthRecs-070814.html
http://www.privacy.org.au/Papers/eHealth-Policy-090828.pdf


-- 
Roger Clarke                                 http://www.rogerclarke.com/

Xamax Consultancy Pty Ltd      78 Sidaway St, Chapman ACT 2611 AUSTRALIA
                    Tel: +61 2 6288 1472, and 6288 6916
mailto:Roger.Clarke at xamax.com.au                http://www.xamax.com.au/

Visiting Professor in the Cyberspace Law & Policy Centre      Uni of NSW
Visiting Professor in Computer Science    Australian National University