Be Patient.

[Matthew X]

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".