Community Medical Records

Medical records – helpful or harmful? We talk about the interests of the people party to your medical record. Too many people feel they have the right of access to your personal information. Plan accordingly.

Erasmus : Communism doesn’t work. Neither do Community Medical Records. The idea that we are all one big happy family, that we can all share for our mutual benefit, belies the fact that often benefit for one person is disadvantage for another.
Dr Xxxxx : Personally I told all many of my patients to make sure that they did not have a community medical record. The system – in particular – employers, police and regulatory agencies all believe that  they have a right to access your information for their own benefit. Employers will often seek your information as a way of validating their actions against you, such as to sack you. Police may be looking for a way to convict you of offences. And if the police are your employer, discovering that you have been on antidepressant medications – may be reason enough to accuse you of having a psychiatric condition and hence to claim that you are unsuitable for working with the public. In a flash, your employment prospects have dwindled forever.

Kinkajou : Community Medical Records can be dynamite for some people. They can destroy lives.

Medical Records
Dr Xxxxx : For the frail and the elderly, community medical records do make sense. When they proceed to a new practitioner or a new hospital, a substantial amount of information is available about the person which can really make a positive difference in the care that the person receives.
Kinkajou : Community medical records can save lives, as well.

Goo : So what we have here is a conflict. There are major positive aspects. There are serious negative aspects.

 

 

Dr Xxxxx : The availability of much health information is perhaps overrated.  No one probably cares if you have caught an unknown unidentified respiratory virus once a year for the last twenty years. A painstakingly assembled health record which shows that you have had flu vaccines regularly for the last 30 years is useful to perhaps someone/somewhere- most likely some researcher, but is not critically useful information.

Many people really do not have much medical information that is worthwhile recording until such time as they become older or sicker or catch something interesting. It is when complex medical conditions arise, requiring complex care and coordination of care, that the true value of the medical record starts to become obvious.

If conditions have been diagnosed, they will often not need to be retested for and re- diagnosed. The Information exists and is unlikely to have changed. Replication of pathology and imaging testing saves time effort and money for the patient, their carers and the medical system funders.

Kinkajou : The biggest savings would be for the funders of the system, hence the reason they are the most keen promoters of medical records.

Erasmus : Most medical record systems work on the community ownership model. And this is a problem because the prime person at the centre of the community medical record – is you. For you , your own interests are paramount. Why should you agree to have and to share information which can be used to harm you?

Communism : Community Ownership

 

Dr Xxxxx : The bottom line is that these issues need to be addressed. In Australia, the system has defaulted to recording diagnoses and medical pathology tests.
Kinkajou : Seems reasonable.
Dr Xxxxx : Not if your pathology tests include sexually transmitted disease testing. Most people would not choose to be outed for their sexual practices. The fact that they are getting regular tests done, does tell you that they are trying to act responsibly to protect their health – and by extrapolation the health of the community. But to have this information potentially “releasable” is deftly not an asset in creating trust with an individual.

Kinkajou : People often interpret such an activity in many ways. You are promiscuous. You are gay. You are careless. You are a bad person and this proves it.

So I can see why information cannot be happily shared by the community. There is too much possibility of an adverse interpretation being attached to your actions.

Erasmus : Doctors also treating you may not be too pleased about sharing all the work they have done.
Dr Xxxxx : Yes. I particularly remember one patient who I diagnosed with a complicated type of UTI. She took my injectable prescribed medication to another doctor, who would probably never have diagnosed the problem by himself. This Doctor promptly  proceeded to give the patient the wrong dose. He earned far more money for far less effort than I ever did being involved in the situation.
And this creates the issue of mediocrity. What is the point of trying your best, and going the extra yard, when someone else can claim all the credit.

Goo : That is not the human way.

Dr Xxxxx : You will earn more money if you run with the pack, then by sticking your neck out. It also allows other people to accuse a doctor of making the wrong diagnosis and of thinking the wrong things. But the world is a complex place. And to be politically correct in thinking about a diagnosis – is not likely to be in many people’s interests. People just want an answer – not a politically correct answer that does not fix their problem. If people become better they are generally happy – even if the thinking that got them there is politically incorrect. (Controversial.)

Goo : So the conclusion is that in a community medical record for a person, there are a number of involved people or agencies with diverging interests. Privacy is a necessity for trust. The patient wants the information private to themselves – and to share this with as few other people as possible, including insurance companies. The doctor requires privacy to think and to work. And requires the privacy to safeguard himself regarding his actions. External agencies need to have only a “limited” right of access to information and a limited/supervised method of access to this information, not the currently open slather access “authorised by  a single signature” that exists today. Even the availability of pathology test results in a community medical record can cause significant harm to an individual.

Erasmus : Bottom line. Communism never worked. Communal ownership of your medical record is probably an idea of the same grade. To the extent you can, consider how your community medical record may help or hinder you. If you think it can be used against you by insurance agencies, employers, police or the legal profession – you need to work hard to limit the availability and access to your record.

The Government grabbing your Information

Dr Xxxxx : Systems relying on typed data input to create structured information are slow and cost (medical) practitioners a lot of time and effort, that no one is willing to pay them for. Consequently the quality medical records generally leave a great deal to be desired. The standard for data input is "Can the computerised system input data as fast and as complex as somebody with a pen and paper?" If the answer is no – the medical record system will likely record less information than paper-based system rather than more.
The main driver for the development of computerised medical records has been the reduced admin cost of creation/filing /storage of the records.

Goo : Notice that is not about making the record better. It’s more about making the record cheaper.

Erasmus : Our prediction is a GUI interface associated with PICT input structures using a pen based “writing” input method overlying an individual-based medical record is probably the only realistic option for long-term success – at least on a technical basis for data input. Cascading menu based medical systems do not reflect how people minds and brains work. People’s brains tend to focus on geography in finding information, (it’s over there on my desk), rather than knowing it’s the third menu down over from the second heading.

Goo : But it is the people considerations that are the most important. How to protect and share at the same time. And too many people especially the government is unwilling to give ground on the right to access to your information.

At this time, think carefully about how your medical record safeguards your health and how it may affect your life if used in a way for which it is not intended.

 

See our enktechs.com site for a much more indepth discussion.

https://enktechs.com/EnneInfo/GUIforHealth.html
https://enktechs.com/EnneInfo/HealthRecord.html