securing distributed partial medical records?

[Adrian Midgley]

Roland Perry wrote:

> And I'm a patient who keenly observes the IT in the surgery.
Good.


> OK, another word then... recommend. The vaccines I had were as a result
> of chatting to the GP and him warning me that the place I was going
> required some jabs, and these... were the ones to have.

You may find http://www.fitfortravel.nhs.uk useful


> I would expect the notes (or more exactly a ledger entry saying what
> treatment had been administered) to be produced automatically once the
> nurse has pressed "done". All the details of the procedure were already
> on the screen, so that she would know what to do.

There is probably a template for filling in, but I'd be wary of assuming
that they tell her what to do (I'd be wary of employing a nurse who was
programmed by the computer  (as an output device for hard copy at that.
 Isn't that the wrong way round?)


>> TYping the record, and then printing a copy of that to stick in your
>> book seems a more logical flow to me, with no more than half as many
>> opportunities for error and inconsistency.  Subclassing and inheritance
>> of data objects or something.
> 
> It's quite a small book and would soon become overwhelmed with sticky
> labels. And the nurse would need a label printer too.
The nurse has a label printer.  It is common practice for laboratory
specimens, and is a useful gadget for other stuff.  The labels are quite
small.

In 1974 at the London Hospital the solution to that class of problem was
to produce a cumulative print from time to time.  GP computr systems are
capable of producing such things.  (The one I wrote does it differently
than the one I use, and actually paid more attention to that)


> I think the nurse types that in, at the same point she checks it's the
> same vaccine that was "recommended".

I'd as soon she scanned the barcode label of the dose, but yes, it
should be got in somehow.

> Which is why I agree there has to be duplication. But in 30 years time I
> will still have the booklet. Based on Wendy's experience your records
> might not be so easily accessible.

You have a high expectation of retention of paper records.   I believe
you, but your experience and anticipation may not be generalisable.
Your one will be lost in the house fire which occurs in 7 years time,
however.

I think duplicating the primary record by printing it for your book is a
good idea.  I think designing two record systems is a less good idea, I
think paying my nurse to handwrite in one of them is soemthing I'd like
to engineer out.

We'll print a replacement label in 74 months, ready for your holiday.


> The vaccination record also serves as a reminder, because it includes a
> date when a booster is needed. 
This is indeed a good thing.  I'd expect tp print it on the label.  Or
in the book if I can have a passbook printer gadget like building
societies use.  Note that the date of booster may vary according to past
immunisations, IE it is a computed date.

> And it also shows the vaccines you
> *haven't* had, which is a different kind of reminder.

Logical error!
It shows the immunisations known at the time of printing and selected to
be ones which you might in due course need or have.  It does not include
the vaccine that will be invented in three years time that will be
strongly indicated fir people with your genotype.  THe practice
electronic managment system will include that.  (Probably in 4 years,
but hopefuly in 2.9)