securing distributed partial medical records?

[Mary Hawking]

In message 
<mailman.4954.1248716143.25782.ukcrypto at chiark.greenend.org.uk>, 
ukcrypto-request at chiark.greenend.org.uk writes

>Before this develops into a three hundred post thread about CfH: I 
>don't like current medical IT systems and I strongly believe there is a 
>need for better records sharing,

Do you mean records or information?
The two are not the same.

> but I don't think CfH is anywhere  near getting it right.

Well, that's something we can all agree on!

snip
>There aren't that many people in the chain at the moment, and the 
>quality of understanding of patient confidentiality is variable. 
>Having a bunch of different systems means that 'information sharing 
>agreements' are tricky to implement, and poorly trained busy frontline 
>staff make mistakes.

Not a techie, but I'm not sure why 'information sharing agreements' are 
tricky because of different [IT] systems: isn't the difficulty in 
defining what is to be shared and under what circumstances and controls?
I.e. organisational rather than technical?
Assuming, of course, that the records are structured in such a way that 
*meaningful* transfer is possible.

snip
>
>>> ii) It would tend not to be "xrays on the xray server" but everything
>>> from Thistown Hospital on Thistown servers, and everything on Thatplace
>>> hospital on Thatplace servers.  Lab results, xrays, MRIs, etc etc get
>>> split up by hospital, not type of service.
>>
>> Actually, they get split up by type of service.
>
>Please could you clarify this?

They certainly would within each hospital!

> And explain why it feels as though one  hospital has little access to 
>records of stuff done in another  hospital?  (Electronic stuff like 
>Xrays are different, that seems easy  to transfer, but why are surgery 
>notes from (eg) Cheltenham not  available to Bristol Frenchay when 
>Cheltenham refer me there?

For the same reason that surgery notes from Cheltenham are often not 
available at Cheltenham..
Paper records can only be in one place at a time.

>[snip]
>> enabling a small number of existing systems to be questioned by a
>> small number of existing systems over a network.
>
>This would be a better way to do things.  Who's going to tell the GPs 
>in a PCT/RHA/SHA that they all have to standardise on one system?

Why do you need standardisation on one GP system to allow systems to 
interrogate one another?
And why limit everything to GP records?
I agree that getting access to non-existent hospital and community 
records electronically is not, at present , very high on a GP agenda due 
to lack of records: ICE (pathology) is a different matter...

Mary Hawking
(Also a GP)
-- 
Mary Hawking