http://www.smh.com.au/articles/2002/08/10/1028158034347.html Health records base a step closer By Jenny Sinclair August 13 2002 Next Data quality and security are emerging as key issues for computerisation of patient health records around the world. Last week's Health Informatics Conference (HIC 2002) in Melbourne heard that patient records were increasingly becoming computerised but the transfer of information between systems still caused problems. The issues could have ramifications for an ambitious project under consideration for a supercomputing organisation. The Victorian Partnership for Advanced Computing (VPAC), aims to use patient records as a massive database for health research. Speakers at an HIC session on electronic patient records told of four projects, all aimed at finding the perfect solution for the masses of information needed in health care. William Goossen, a researcher and consultant to a Dutch attempt to set up a national electronic patient records model, said the Netherlands had needed to combine many attempts at creating such systems. The answer was to set up a national effort, bringing together the government, health providers and nursing associations in a single body. Major factors in a successful patient records system were identified as the information structure or content, the technical infrastructure, safety and security issues, and having the new body "do the work" of developing a workable solution. Professor Bill Appelbe, chief executive of supercomputing group VPAC, has said he would like to see standards set up for bringing together all kinds of medical records and tests. Speaking before the conference, he said that most information from clinical trials was only available in hard copy and recorded manually. This made "data mining" impossible, depriving researchers of potentially valuable sources of information. Similarly, having the general population's health records available electronically (in an anonymous form) would allow the possibility of faster and more accurate medical research. He said VPAC had had interest from large software vendors in developing such systems, acting as a "trusted third party" to broker between the medical research industry and large database developers. VPAC could take part in developing such specialised systems by "applying modern software development (principles) to scientific software" and hiring out its supercomputer's data-crunching facilities. In Victoria work has been under way on a universal health-care database for mental health patients for five years. The database project has been slowed by problems with messaging systems transferring data and by user feedback on early versions. The Victorian mental health-care approach has been to develop a centralised database with a unique patient indentifier, and to link it to clinic and hospital systems via an intermediary interface, pending development of a universal solution. The database was divided into an archive database and an "operational data store" for current work. Speaking for the project, Damian Curran said issues of training, insufficient bandwidth to local clinics and corruption of records had all needed to be overcome. The department is about to move to a new phase of trying to connect clinics and hospitals directly to the central database. Curran said key lessons from the project included the need to have proper documentation to allow for staff moving on, close monitoring of subcontractors, making sure the work kept up with current practices in the medical field, and "it's not cheap" - costs could be high. At the Distributed Systems Technology Centre (DSTC) in Queensland, trials of a so-called "Good Electronic Health Record" (GEHR) are about to move to real-world testing. The GEHR is a worldwide attempt to standardise the way medical records are kept. Researcher Andrew Goodchild said the group had had excellent feedback from doctors participating in the trial. The DSTC has helped develop editing software that allows medical practitioners to create simple "archetypes" or templates in which to store different kinds of information. The templates have parameters built into them that allow practitioners to specify what information must be entered, and what ranges are normal; so a template used to report blood tests, for instance, can automatically identify results out of the normal range. Goodchild said that anyone setting up a records system for doctors should first "find out what's politically and culturally, and work-wise acceptable for the clinicians". The trial editor will be available for free download from the DSTC's site soon. A working electronic patient records system has already been set up at the busy emergency section of the Austin and Repatriation Medical Centre in Melbourne. The hospital engaged Sydney software company TrakHealth for the pilot scheme, which has allowed the emergency room to replace its giant whiteboard showing patient movements and conditions with a computerised version. Applications project manager Vicki Moritz said the electronic "whiteboard", set up as a floor plan of the emergency room, increased privacy for patients and had interactive features, such as a clock symbol that flashed when patients were due for a check-up. The hospital chose its system by having about 100 staff road-test a shortlist of programs. She said information needed to be carefully checked before it was transferred to a new records system; two patients gave their occupations as "domestic goddess" and "stud".