Re: Warning of major NHS IT overspend

[Dave Howe <[EMAIL PROTECTED]>]

Brian Beesley wrote:
> Why does everything have to be stored centrally?
It would appear that that is not for anything more operational than the 
fact that the government wants it that way - as has already been pointed 
out, these aren't the patients records, but records about the patient; 
the system appears to wish to establish the fact that these aren't the 
gp's records, but records held at the gp... by removing them and putting 
them in one central and highly data-minable location.

> Why cannot the files be retained where they are and links made to them in the 
> new GP's system?
this would be better for the stated purpose - of making the files 
available to a remote doctor - while worse for asserting control over 
that data from a central point.

> Yes. The point here is that "decently readable" scans of x-rays require a 
> huge amount of storage. A hi-res scan of a 35mm frame can easily run to 100 
> MBytes; X-ray plates are over 100 times the area. Of course data compression 
> techniques (or reduced resolution) can be employed but sometimes vital data 
> will be obscured, making the value of retaining the scan moot - at best - it 
> stands to reason that if a scan failed to show a critical detail which was 
> present on the original film, a misdiagnosis could result.
Hence the best solution would seem to me to be a progressive scan on demand.
remote user requests x-ray, which is loaded into a scanner. scanner does 
a medium res scan, transmits to remote user. user draws box, box is 
rescanned at 16x original resolution. rinse, repeat until remote user is 
happy, then eject xray and reset for next user.


> If you're prepared to store potentially terabytes of information per patient 
> (hi-res scans of a few dozen x-ray plates), there doesn't seem any reason to 
> transcribe handwritten notes at all - just scan them & record the scans. This 
> reduces the cost and skill needed in the area of transcribing notes, and 
> probably the error rate in interpreting the notes when they are referred to.
Indeed so, yes.

> ... with errors resulting from judgements made in interpreting other peoples' 
> handwriting....
yup, and that will always be with us. the only difference being there 
would then be a single interpretation made, instead of a medium-res scan 
of handwriting meaning the potential for error crops up every single 
time; the writer will blame the scanning, the system will blame the 
original writer...

> Yes, so at the very least existing paper records should not be thrown out for 
> the sake of "modernization", and systems for storing, transmitting and 
> displaying electronic records should be designed to resist breakdown. (Up 
> goes the cost again, reducing the cost effectiveness of whatever value the 
> switch to an electronic system may have.)
yup. I don't recall "its cheaper this way" ever being put forward though.