Wednesday, 28 October 2015

Health records on-line

everyone? Don't opt in to this but opt out? 
There are new plans for a national on-line system for accessing a patient's health records.
We are told it has advantages. It potentially means you can go to a health professional anywhere in the country and they can access your health records. It means that someone who falls ill on holiday can get medical help knowing that their medical records can be brought up immediately. It means that, in the event of an accident, health records may save someone's life.
There are claims that it will save time and that it will improve the medical care available. 
Perhaps. I have my doubts. 
Records are fine if they are (a) accurate, (b) honest and (c) up to date but should they also be available to everyone who provides you with health care?
I have seen my medical record at my GP. My GP obligingly turns the computer screen around so we can look at it together. There is nothing very remarkable on there - certainly no record of the spat I had with a misogynistic male GP. My GP treats me like an intelligent individual with a better than average level of medical knowledge in some areas.  She adjusts her vocabulary level so that it is appropriate to the circumstances. I have heard her do it. She talks to Middle Cat like another health professional. She uses technical language with me. With the Senior Cat she uses language which says, "You are intelligent but I know you may not always know the technical terms" and with an elderly Greek Cypriot migrant she explains slowly in plain, simple English and does it twice if necessary asking questions to make sure she understands. I know. I have heard her do it. 
We are fortunate in that she does communicate well. Many doctors don't - even though they try.
So you get medical records that are only as up to date as they have time for and they may or may not be accurate for any number of reasons. 
It may also mean that patients need to know more than before. The next health professional they see might ask, "You have...? What are they doing about that?" or "Are you taking..... or.... for....?" or "Have you noticed a change in X or Y recently?"
If a doctor is merely monitoring a potential problem then does the patient need to know if nothing can or should be done about it? Does it give the patient something more to worry about? Will they turn to Dr Google to find out more and then start self-medicating in an attempt to halt "the problem"? What do you tell the patient in these circumstances?
There is also the honesty issue. On the old, written records there was plenty of "code" for things like "this patient is an hypochondriac" or "this patient is rude" or "this patient does not take advice well" or.... well you can imagine plenty more. The information was not usually shared with other doctors. It was just there to remind the doctor who had written the notes. Doctors are not going to write such useful but potentially dangerous remarks on records that could be seen by anyone.
And I do mean anyone because any computer system can be hacked. Of course if you "opt out" people will say, "Oooh must have something to hide then." But it might be that you just don't care for the world to know about your medical history.
I can think of more issues but those above are, to me, the most obvious. I can think of some partial solutions too but they would be too expensive to implement.
It is an issue which still needs more thought than the government seems prepared to give it. 


Stroppy Author said...

An elderly relative of mine was taken into hospital - not his usual hospital - at 5am yesterday. They don't have his records. None of his daily medications are available to him so well-managed conditions are getting worse while they try to get paper records and we take in pills from home and hope he will be given them. If the hospital could see his records, his care would be better. It only needs security levels and a permission-to-know button. I really wish he had electronic records. On the other hand, I have a friend with mental health problems who, whenever she goes for treatment for a physical problem, has her mental health history brought up because doctors see it as a red flag- -it's nothing odd, depression and an eating disorder. That's from looking at paper records, so it can happen either way rounds. Personally, I think the chance to save a life is more compelling than the worry that someone might know my medical past, but I do think we should have the option to have shareable records.

catdownunder said...

Yes, would prefer "opt-in" to "opt-out" and would really like to see a "need to know" system so that medication can be administered - but that would be expensive. The "save a life" issue is the most compelling one though.