Saturday, December 06, 2008

Security & web based electronic medical records

Houston Neal has posted an interesting discussion on The Software Advice Blog entitled The Double Standard for Web-Based EMRs . In it he questions why doctors would be happy for all their banking to occur over the Internet, but are unhappy to use similar technologies for their patients records.

He makes some good points and provides an interesting checklist of questions to ask software suppliers, but I feel he doesn't fully address the key point which is that many people would be much more worried about aspects of their health history (classically mental health, gynaecology or sexual health) being in the public domain than their financial details.

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Friday, August 29, 2008

XO Laptop, or One Laptop Per Child Project: An Extension Idea for a Sturdy Tool

I woke up at 4 a.m. thinking how great it one be to apply the One Laptop Per Child (OLPC) XO Laptop ( to several ideas.
  1. Educating children on health: It already has education as a mission, but I wonder how much of that is devoted to evidence-based health education practices? It uses gaming too, so it could also be adopted by groups such as Games for Health ( And, projects such as Re-Mission ( could be a model for how it teaches children compliance and self-care with other diseases.
  2. Medication Tracking and Compliance: In the US and other country rural areas, it could have something similar to the My-Medi-Health project, which aims to investigate and research methods for improving compliance among children. What about a module within it that has a personal health record? Or even one which encourages the child to document vital signs, medications, and treatments and then can beam it back to a provider's computer in the clinic? (
  3. A Remote Healthcare Provider Computer: This computer has incredible potential for remote areas for having a more robust electronic medical record. It could act as a repository for data until the healthcare provider could get back to a central computer and then, using its wireless abilities, beam them back into the main database (sync them up).
  4. Home Health Care for Rural Areas: As above, especially with nursing modules it could bring about cheaper care and bedside documentation for nurses in the field.
  5. Disaster Relief Use: What about developing a special model of this very durable PC for use in mass casualty disaster situations? Especially since it comes with a hand crank, and after disasters we often don't have battery and networking capabilities, note that it has a hand-crank to recharge and it has wireless social networking software built in. So, it could not only tell you where other healthcare providers are in the command zone, but share information on triage and treatment. Just a little retweaking of the system and it's ideal... especially because it is designed specifically for sturdiness, including water and sandproof and dropping and so on...
  6. Transcultural Care: The team using it are experts at symbolization and crossing language barriers. They could help develop a universal standard, or even several language algorithms, for helping international aid workers work together in mass casualty.
  7. Special Needs Children: I wonder how well it would work for autistic children and others within that spectrum, especially combined with
  8. Accessories: Could other equipment be developed to accompany it? For instance, a Wii Fit board to measure weight in the field, or something sturdier and just as cheap (the board itself is $87 retail or so bought directly, not through marked-up online vendors). Or, blood glucose monitoring devices and such? A blood pressure cuff?
  9. Field Database: Could a more remote version be created for use as field command centers? Even have database server versions, using the peer-to-peer wireless, to collect data? Not just for mass casualties, but healthcare in remote areas? Again, a sturdier, server version, but bring it back to the main computer and sync it up, perhaps in a healthcare truck, van, airplain, or helicopter or such? Valued data could be used for research, health care improvement, disease tracking, and even fundraising. Think of the value to groups like the Red Cross and Red Crescent Societies. The CDC could really benefit from point-of-impact data collection.

What would it take to raise the money for it? Could the XO team help raise the money to form a separate group to investigate using it this way? Maybe even the Vanderbilt School of Nursing faculty and staff could be involved and find grants to make this happen? Maybe a research project for a grad student or two? Are there others who are interested in seeing this happen? Is it visionary?

Just some thoughts. Thanks for listening! - Richard Aries, MSN, RN, EMT

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Tuesday, August 12, 2008

While the standards world was besotted with terminology over the last 20 years, clinical modelling remained relatively unloved and under-resourced, with the occasional exception (eg GALEN) proving the rule. It may have been obvious that terms would never 'enable' the EPR without some structures to hang them on, but it has taken a while for this to get more serious attention in the informatics mainstream.

Clinical content standards development is now a fast growing area of informatics, and is one where clinical and informatics expertise needs to collaborate closely. In the UK, most recent interest in standards has focussed on openEHR archetypes and templates- eg NHS Clinical Models.

While the standards (and the standardised models) sort themselves out, the world moves on, with everyone and their dogs developing their own content, sometimes sharing it, usually not. Clinical content remains embedded in working systems, often wrapped in licensing agreements preventing sharing and re-use. Standardised tools are used, without any attention to copyright restrictions that might apply.

There has been previous work to address this, for example, 'Tools and Rules', but there is scope for something more long-term and 'open'.

The new site has just gone live as an open source portal for various projects working on the collaborative development and sharing of clinical templates and supporting documentation.

The project offers a web ‘shell’ for each collaborative project site, supporting groups, membership, news, blogs, newsfeeds, and wiki. Within that, the project is developing a range of plugins to support template building, mappings and other project-specific tools.

New projects are in preparation and will appear on the site over the next few months- each one is a little different and should build into an interesting collection. aims to become a long-term home or point of access to template development by many groups and in many countries. It is supported by a new company setup by Derek Hoy and Nick Hardiker.

[disclosure of interest: I am a lead developer of and partner in SnowCloud]

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Tuesday, May 06, 2008

Report of Evaluation of Summary Care Record Early Adopter Programme

An interesting report has been published today into the evaluation of the Summary Care Record (SCR) Early Adopter Programme. It highlights many of the difficulties which have been encountered and makes recommendations to improve for the future.

The evaluation team led by Trisha Greenhalgh at University College London discusses criticisms of the programme focusing on "implementing a technology rather than a broader and more developmental focus on socio-technical change". They also make comment about the ethical and moral considerations inherent in the "current ‘hybrid’ consent model for the SCR, which is widely seen as overly complex and unworkable (and which many GPs and Caldicott Guardians see as unethical), and consider alternative models, notably ‘consent to view’, that have been shown to be acceptable and successful in comparable programmes" in Scotland and Wales. This was despite the fact that few of the patients in the pilot area reported strong feelings about whether they had a SCR and low levels of "opt out".

The report also criticises an "outdated model of change – centrally driven, project oriented, rationalistic, with a focus on documentation and reporting, and oriented to predefined, inflexible goals", and argues for "more contemporary models of change (which are programme-oriented and built around theories of sensemaking, co-evolution and knowledge creation) include soft systems methodology, technology use mediation and situated action".

The full (138 page) report is available from, and although I've only read the executive summary so far I think it should be compulsory reading for anyone involved in electronic health records.

Further commentary and discussion is taking place on the E-Health Insider site under Urgent review of SCR consent model recommended and elsewhere. It will be interesting to see if the lessons learned will be put into practice.

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Friday, March 16, 2007

1st uploads from GP to national spine

The first upload of GP patients records to the NPfIT national spine are about to start.

Bolton has been selected as the pilot site and two GPs practices in the town will begin uploading GP records as part of the "summary care record" which will contain containing details of name, address, medication history, serious illnesses and allergies. These will then be accessible to the out-of-hours provider and A+E department.

Letters and leaflets explaining the programme will go out in the next few weeks, and local residents will have the option to "opt out". This long fought for opt out will have three possible options. The first is a total refusal for their records to be uploaded. The second option is to limit the people who are able to access it and the final options is that particular details - such as an abortion or being on HIV medication - must not be uploaded (the so called and long awaited sealed envelope). However, very few details of how this will be achieved have yet been made available.

It will be very interesting to see how many people take one of the options to restrict the use of their personal and sensitive information.

Further information is available from:

* The Guardian 15th March First test launched of NHS's controversial 'Spine' database
* E Health Insider Starting gun fired for Summary Care Record roll-out

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