Arguing For Open Electronic Health Records 111
mynameismonkey writes "openEHR guru Tim Cook, writing in a guest blog at A Scanner Brightly, discusses why Electronic Health Record developers should use open standards. Why are so few doctors using EHR systems? And, as more and more hospital EHR systems come online across the country, what do we have to fear from proprietary databases? It's one thing to find out your social security number was stolen. Now add your mental health and STD results to those records."
Re:I seriously doubt it (Score:5, Informative)
In the UK, the government has invested vast sums of money into a system called "Choose and Book." It's billed on the slim selling point of offering patients greater choice in hospital care but the most cursory look at the technology involved shows that the biggest effect is that of centralising patient's records.
Aside from the fact that patients can be offered a choice in secondary care already (by their doctor referring them to somewhere else), the system is buggy and flawed. The doctors don't want it, there have been national campaigns by the public against it, but the government is doing every single thing they can to force it on people up to and including financially penalising doctor's practices for not using it. The motivations are (a) presumed financial interests in the big companies that are providing the system and (b) a burning desire to get hold of everyone's personal medical data for government and police purposes.
It's not even legal as the responsibility for patient confidentiality belongs to the patient's own GP and if there's a misuse, they will be the ones legally to blame for sharing the data. There's some information on it here
If there's a need for easily transportable medical records, then this can be resolved by putting the data in the patient's hands. Public-Private key technology, or even hashes of the data, could be used to ensure accuracy. The solution is not that complicated, but in the UK we're having a very hard fight getting it.
Re:I seriously doubt it (Score:3, Informative)
It's a data exchange format that *all* health care insurers and providers must accept or provide when exchanging patient data. It's trivial to add to the spec rules for additional subloops containing text. There are codes and modifiers enough to cover damned near any medical situation.
Many small doctors avoided electronic data altogether by doing as they'd done for years, namely keep paper records. That is until insurance companies began deprecating paper... by not accepting paper claims at all, charging a premium for processing paper forms, or cutting staff levels in their data entry pool which has the effect of seriously delaying payment to the physician.
Re:VA system is public domain (Score:2, Informative)
updated it to "VistA", which predated Microsoft Vista (wonder if Microsoft chose that name for a medical reason?).
VistA® / CPRS Demo Site:
http://www1.va.gov/CPRSdemo/ [va.gov]
The code:
http://www1.va.gov/CPRSdemo/page.cfm?pg=1 [va.gov]
http://www.innovations.va.gov/innovations/docs/InnovationsVistAFAQPublic.pdf [va.gov]
http://www.va.gov/VISTA_MONOGRAPH/index.asp [va.gov]
http://www.va.gov/vdl/ [va.gov] is the library.
http://www.va.gov/vdl/section.asp?secid=3 [va.gov] covers your Financial question.
http://www.va.gov/vdl/application.asp?appid=144 [va.gov]
VistA Data Extraction Framework (VDEF).
http://openvista.sourceforge.net/ [sourceforge.net]
"OpenVista is the open-source version of VistA, which is an enterprise grade health care information system developed by the
U.S. Department of Veterans Affairs (VA) and deployed at nearly 1,500 facilities worldwide."
1,500 is not all that many considering the market.
Intersystem's Cache' http://www.intersystems.com/cache/ [intersystems.com] is the contemporary equivlent to MUMPS, a database that claims it can
run rings around things like MySQL in the number of transactions per second.
There are a number of Open Source Medical Databases,they are summarized here:
http://www.linux.com/base/ldp/howto/Medicine-HOWTO/record.html [linux.com]
My very first job was writing medical software, this is when few people even knew what computers were in 1977. Still have my DEC
MUMPS badge that I got at the very first MUMPS conference in DC. Have always felt I should get back into that field. To bad
Dr. Armor and I didn't patent what we were doing then. The pharmacists called up the office in disbelieve asking if these
computer printed prescriptions were real, because *THEY COULD READ THEM*.
The other side:
"VA DATA AND INFORMATION SYSTEMS:
1. FY07 Year-End Med SAS and DSS CNDE Files Available
The fiscal year 2007 (FY07) year-end Medical SAS (Med SAS)
Inpatient and Outpatient files are now available."
http://www.virec.research.va.gov/References/DataIssuesBrief/2007/DIB-0712er.pdf [va.gov]
Requesting Access to VA Data:
http://www.virec.research.va.gov/Support/Training-NewUsersToolkit/ACRSrequest.htm [va.gov]
"Click this button for information, guidance, and FAQs relating to the VA Research Data Security and Privacy initiative."
http://www.research.va.gov/resources/data-security [va.gov]
Arguments for and against. (Score:4, Informative)
In that way old fashioned plain images are better.
Having open source images/records would also eliminate that problem too, as I could display the images, and not have to find/buy/ download some strange/clunky program.
Most radiologists and newer surgeons really like electronic imaging, but it can backfire on you as well.
You own it (Score:3, Informative)
* Not all data in an EHR system relating to you is actually part of your medical record. There may be - probably is - some internal clinical communication attached to your chart in the course of clinical operations. Basically an EHR system usually tracks both your record and the providers' own record about you. These different classes of data are pretty straightforward to distinguish most of the time; you own the former and you don't own the latter.
* Providing you with a copy of your record has some cost, and custodians of records are allowed to recover reasonable costs from you to cover those expenses.
* Some data about your records may be disclosed as necessary for Treatment, Payment, or healthcare Operations; these disclosures are limited to the minimum necessary and (generally speaking) are also limited to other entities coveredby HIPAA.
* The government can get what it wants, when it wants, and you and your records custodians have f--k all to say about it.
Within those broad costraints, though... it's yours and your provider should treat it as such.
Open standards already exist (Score:2, Informative)
With these a PACS (Picture Archive Communication System) forms the "database" of data. The PACS is actually more work-flow based which then stores the actual data on some type of highly-reliable data storage system.
These two protocols make up the totality of your health care experience at a hospital. Your hospital certainly uses these two protocols, so why invent a new one?