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Yeah, I have. A health record is a collaboration - unlike a medical record, which just shows a slice of your health from the perspective of a single institutio

Yeah, I have. A health record is a collaboration - unlike a medical record, which just shows a slice of your health from the perspective of a single institution, a health record aims to show as many facets as possible. An EHR system should be agnostic about who access the record, and what they use it for - obviously gps, specialists, hosptitals, labs, the patient should all have access - but what about, as your said, software? The ideal system would be,patient visits your system, goes through an OAuth flow, and your system has api access. The tricky part is format. Its really hard to define a format which fits the entire world's use case. If you consider, what is healthcare information - you realize it's any data relevant to the patients health. So how can you even start to define that? My compromise is a system where formats are promoted to become popular, regionally, and condition specific. So if you're building a machine learning readmission software, you can target a specific market - say British Primary care, or a specific condition, say diabetes. You can expand out to other markets by writing transformers to translate from one regional format to another.

phkahler 10y ago
It would be best to have a model where the patient "owns" their own records.
numbsafari 10y ago
So, if I want to run an daily analysis of every record in your system, does that processing happen on your system, or do you somehow replicate the data to me? I guess my point is... it's likely that you may want a "single source of truth" for the data, but farm out copies for other applications. And once you do that, you probably want some kind of "replication protocol" that sends updates, rather than making a full copy of the data every day. And once you've done that, aren't you right back where we are today?
- JusticeJuice 10y ago
  It's a self hosted system - so you as an institution have a copy of all of your patients records on your own servers, which you control. So analyse away. What it provides is a way to replicate some or all of the record to other health institutions. Say, you share the patient's medication list with the hospital - they also keep a copy. When you prescribe a new medicine, the hospital's copy also gets updated. And yes, arguably this is just another version of interoperability. However, if you want to share healthcare information, in a way which allows institutions to have freedom, it's unavoidable. The concept of interoperability isn't bad, just the implementation is. The alternative is all patients records are kept, and accessed from the same place. However, this is very tricky. Many governments have tried to make national health record storage systems, which had immense budgets, and didn't really work out. Often with systems controlled by one party, it's hard to work on ideas which don't fit their goals. Say if you have this great idea for a new format to manage diabetes - that wont fit into their standard format, and you'll have to work outside of their system. Not to mention the control over the population this organisation would have. Patient owned and controled systems are often suggested, and have been built, but I've never seen one work. Patients expect their doctor to manage their record - and they pay for them. It would be a huge challenge to get every patient to pay their yearly 'health record server fees'. On top of that, heath records also belong to the doctors - legally in NZ they have to keep a copy of your record for 10 years since your last visit. For their own liability they need access. In my mind only two models can really work - Goverment run systems which are run better than current systems - A better take on the interoperability model

phkahler 10y ago

It would be best to have a model where the patient "owns" their own records.

numbsafari 10y ago

So, if I want to run an daily analysis of every record in your system, does that processing happen on your system, or do you somehow replicate the data to me? I guess my point is... it's likely that you may want a "single source of truth" for the data, but farm out copies for other applications. And once you do that, you probably want some kind of "replication protocol" that sends updates, rather than making a full copy of the data every day. And once you've done that, aren't you right back where we are today?

JusticeJuice 10y ago
It's a self hosted system - so you as an institution have a copy of all of your patients records on your own servers, which you control. So analyse away. What it provides is a way to replicate some or all of the record to other health institutions. Say, you share the patient's medication list with the hospital - they also keep a copy. When you prescribe a new medicine, the hospital's copy also gets updated. And yes, arguably this is just another version of interoperability. However, if you want to share healthcare information, in a way which allows institutions to have freedom, it's unavoidable. The concept of interoperability isn't bad, just the implementation is. The alternative is all patients records are kept, and accessed from the same place. However, this is very tricky. Many governments have tried to make national health record storage systems, which had immense budgets, and didn't really work out. Often with systems controlled by one party, it's hard to work on ideas which don't fit their goals. Say if you have this great idea for a new format to manage diabetes - that wont fit into their standard format, and you'll have to work outside of their system. Not to mention the control over the population this organisation would have. Patient owned and controled systems are often suggested, and have been built, but I've never seen one work. Patients expect their doctor to manage their record - and they pay for them. It would be a huge challenge to get every patient to pay their yearly 'health record server fees'. On top of that, heath records also belong to the doctors - legally in NZ they have to keep a copy of your record for 10 years since your last visit. For their own liability they need access. In my mind only two models can really work - Goverment run systems which are run better than current systems - A better take on the interoperability model