RE: Warning of major NHS IT overspend

["Owen Lewis" <[EMAIL PROTECTED]>]

> -----Original Message-----
> From: [EMAIL PROTECTED]
> [mailto:[EMAIL PROTECTED] Behalf Of Adrian
> Midgley
> Sent: 02 November 2004 02:08
> To: [EMAIL PROTECTED]
> Subject: Re: Warning of major NHS IT overspend
>
>
> On Monday 01 November 2004 07:57, Owen Lewis wrote:
>
> > I think the point is that a UK national medical record scheme
> is intended
> > for use in the UK.
>
> That would be a very limited ambition.

Possibly. But in the absence of an EU scheme (and the attendant language
difficulties), a proper one I think.

There is no exclusivity implied; only a main purpose.
>
> > Also I find it a bad idea that the patient should be empowered
> selectively
> > to block access to specified entries in the record to clinician
> A but not
> > to clinician B. Such inexpert meddling can surely produce no good
> > consequence
>
> I promise you, in this respect experts are involved in the meddling.

If, as pre the reference, it's the patients who meddle then, almost by
definition, any effect on treatment will be inexpert.
>
> An underlying assumption seems to be that the information will be
> in there.

Quite so. I am not suggesting that there patients be required to give any
information at all. Rather, all information that is in the file should be at
the disposal of any clinician who has the need to see it. By 'need' I mean
that the patient has been referred to or is otherwise arriving for
consultation, treatment etc. at the establishment summoning a copy of his
file. Having over quite some years been involved in 'ripping the guts' out
of thick files to get at what is relevant to professional interest at the
moment, I think it is one example where less is not more. The purpose of
provision of the whole file is to allow balanced judgments to be made in the
knowledge of what is contained in the file. The person best placed to decide
on relevancy is the person whose responsibility the decisions are. An
essential part of any voluminous filing system is a summary record of the
dates and events that are recorded in the file. If this is trustworthy, this
is the guide that any delving for information will first refer. It is a rare
event indeed for such a file ever to be read from cover to cover.

There may be a partial analogy with the provision of elements only of a
legal case for an expert report. Here, the need to be selective in what is
put before the expert is often essential because:

		-	The full case papers may fill a room and the time required to rip
through unannotated files would be a sadly time-wasting and cost ineffective
exercise. The effort required is, I'd expect, altogether on another scale to
reviewing one patient's medical record.

		-	The wish to keep the experts mind 'unclouded' by aspects of the case
which are outside his sphere of competence and/or the limits of his brief.

Nevertheless, the effects of restricting too closely the case papers made
available can have unexpected and sometimes unwelcome consequences.

> But the easiest way not to tell B something is to not tell anyone.
> If it is something of proper interest to both Pt and A then there is your
> non-occasional problem.

Yes, but I think we need to be clear as to what we refer to here. Pt is free
not to volunteer information for the file. Whether he attains any good end
thereby is an open question - but it's his decision. Where information with
regard to treatment and other aspects of Pt care have been added to the
file, I do not believe that it is in the best interests of either Pt nor
those who provide him with medical care that Pt shall be allowed to
interfere arbitrarily in the flow of what is, properly, medical service
information.

Owen