BBC medical records story

[Peter Tomlinson]

What do I say? I have sat in on, or read about, a number of discussions of
both practical and theoretical schemes for digitising medical records. Then
last Friday I was visitng a very sick friend, two days after his admission
to a local hospital, still in one of the admissions wards because there was
no bed for him in the main hospital. And a nurse asking me about him - this
was his third major admission, but I don't think that she had access to his
records, scattered as they are across two major hospitals and who knows
where else. I suspect that, when he was admitted, the only briefing that the
A&E people got was from his wife (he's lucky: he has a very competent wife).
Now I'm not able to decide whether having instant access to all of a
person's records is going to make a significant difference to the outcome or
even the patient's experience while in hospital, but it sems to me that
having acess to key items might be a big help.

Then both my doctor and another doctor who I know have confirmed that their
workload has increased dramatically over the last few years, so we have to
do what we can to assist them. At least my local health centre has been
computerised - my doctor enters his notes on a terminal, and the nurse does
the same from her desk. And a friend of mine installs and maintains this
type of health centre systems.

1. There is an emerging consensus, certainly in Europe, that information
carried on a citizen's card must be backed up somewhere, so that the card
can be recreated (and, as far as the ethical public sector is concerned, so
that problems can be solved by analysing the records).

2. At the point of use of the information, the terminal having access to the
card must also (if it has the right to change or add to the information in
the card) at least be capable of going online to a central system even if it
normally works offline. The converse is also true: the terminal must be able
to provide as much help as possible to the medical practitioner when
operating offline. the terminal is used to enter information, then the link
to the back office sends it off for backup and to join the patient's main
database entries.

3. There are clear situations where offline use of a smart card can help the
practitioner help the patient. Those giving emergency treatment, for
example, will be assisted if the patient carries a card which is a photo ID
card and carries information about allergies, regular medication, etc (you
medical people can work that out). But I also remember reading about a
project where a group of patients, all suffering from the same problem, have
been given a smart card into which each person who treats them enters data
and from which those same people can see the recent history of the patient -
and the patient also participates through a smart card enabled internet
terminal at home.

So we have special groups of patients for whom medical treatment can be
improved by their having a card which contains some medical records, as well
as having records in a database to which the card can be linked. Whether
this should be extended to everyone is a moot point, and in the UK's
nationalised health service I don't think it should automatically be rolled
out to everyone. But an insurance driven health service, very strongly
controlled from the centre, will want everyone to have a card and to have
the central database as well.

Then, in the UK scenario, we need a resilient network of multiple back
offices, and not one central monster database. Decentralisation, but working
to common specifications and standards. If I'm normally only going to my
local health centre, keep the records there, keep the key information on my
card along with the key to where the rest of it is. If I then end up in
hospital, the hospital can use my card to access the system that holds them.
For other treatment regimes, again you can work it out for yourselves.

Yes, there are security problems, and even Bill Gates appears to have
realised that. Many of us will take the risk, but the professionals must
carry on pushing for more secure systems to be the norm rather than the
rarity that they are now.

Decentralisation for the back offices supporting driving licences,
passports, and citizen ID cards as well, please.

Peter T
Bristol UK

----- Original Message -----
From: "Roland Perry" <roland@linx.net>
To: <ukcrypto@chiark.greenend.org.uk>
Sent: Thursday, March 07, 2002 1:53 PM
Subject: Re: BBC medical records story


> In message <1015420904.15049.169.camel@hyena.skygate.co.uk>, Pete Chown
> <Pete.Chown@skygate.co.uk> writes
> >Roland Perry wrote:
> >
> >> They will expect whoever issued the card to keep a backup.
> >
> >But if they do that, why have people carry the data around?  Why not
> >just get the person to identify him or herself and then read it from the
> >"backup"?
>
> You are making the unwarranted assumption that the public is applying
> logic to their sound-bite support of the scheme - all I'm saying is that
> I'm sure the public would expect to be bailed out if they lost the card,
> and a backup is the only mechanism I can think of.
> --
> Roland Perry
>
>