[LINK] Your Medicare records online

[Birch, Jim]

Dr Bob Jansen wrote:

> Maybe this represents a compromise over where the stuff gets stored. A

> small proportion of the really necessary stuff on central, government

> run, servers and the rest with me so I can protect my security. That  
> way I control who gets access to the detail whilst still having the  
> necessary stuff available when needed.

Your Medicare record will only limited information like demographic data
and a list of Medicare item numbers, practitioner and dates.  This isn't
a health record that a doctor would consider using, except for specific
limited purposes.  OTOH you might be able to guess a bit from it, say,
if you were flogging life insurance, but you'd probably do about as well
with demographics and a few questions.

Hospitals have multiple systems which generally lack full integration.
The main hospital patient administration system (PAS) traditionally
contains demographics, and details about when and where the patient has
been and who looked at them.  The real medical data is distributed
through a lot of other systems, emergency medicine, pharmacology,
oncology, xray, etc.  These systems contain a fair bit of embedded
expertise and practice so (eg) a PAS vendor won't be able to match the
best oncology system.  This federated system presents numerous
integration problems.  Hospitals are constantly trying to provide better
integrated views of their data although the full detail will reside in
the specialist systems.  PAS vendors incorporate some modules like ward
systems that will contain medical information but won't have specialist
level detail.  Some vendors are attempting to create super applications
that encompass all specialities in a single integrated application.
This has proven difficult.

GPs and specialists are other islands of data.  They probably believe
that it's their data, rather than the patients or anyone else's, but
most of the GP systems couldn't support remote interrogation with
granular authorisation anyway.  There's a massive problem with
incompatible data formats, record standards, and even nomenclature for
medical symptoms, conditions, and so on.  Patients often fail to tell
their GPs that they have been to hospital, even with serious conditions.
Public health systems try to notify GPs about hospital admissions and
provide a discharge summary for the GP's records if the patient OKs it.
Some doctors don't want it.  Information transfer the other way is
fairly haphazard too. GPs may write a one line referral letter.
Hospital doctors may occasionally ring a patient's GP and request
information.

AFAICS a complete integrated health record is a long way off and current
federated model will persist for a long time, with gradual improvements
in standards and capability for remote access on a need to know basis.
This access will be managed in a federated model too, patient X allows
agency Y to make their records available to agency Z.  

It's worth noting that medical practice doesn't put absolute faith in
records unlike, say, a bank.  Records are very useful because it takes
time to take histories and patients have limited knowledge about their
own conditions.  However, apart from the obvious need to improve on
prior diagnoses that were incomplete, inaccurate or plain wrong,
patients change, and so do tests, diagnoses and treatments.  That's
probably got a lot to do with why the current system is as crazy as it
is.

Jim

Disclosure: I work in IT in the public health system but I'm not fully
informed about anything (at all).  Here, our knowledge base says we
support 320 client applications, though a few may be missed.  Most of
these are medical but some provide administrative, decision support,
etc.  I guess a hundred or so contain information that might be called
"medical records".


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