5 ms·

It seems overall okay if you accept the premises that A) A centralized health record system can do substantial good by improving effectiveness and transparency

It seems overall okay if you accept the premises that A) A centralized health record system can do substantial good by improving effectiveness and transparency of healthcare processes, and enabling medical progress through data re-use. B) Doctors won't lift a finger to do extra work if they have no selfish incentive for doing so.

TheSpiceIsLife 8y ago
C) the database never gets hacked, or leaked, or otherwise exfiltrated
- jopsen 8y ago
  Even if there is a risk of this. It might be a risk worth taking. Edit: I don't know the specifics, but I sometimes wonder what good stats on more health records could do for future treatments.
  - vertex-four 8y ago
    I wouldn’t intentionally place my health records out of my own control, because I have significant risk to my life if those records become public. Having certain illnesses and medical history is inherently political in 2018 - being trans can result in violence against you, talking to your doctor about STIs - even just prevention - can get you kicked out of your home, having medicated/treated schizophrenia will result in losing job/housing/etc opportunities. This isn’t going to change even if all those records become public in some way.
    - pimmen 8y ago
      But you also have a significant risk to your life if your doctor can't get to them and orders the wrong treatment. The risk of that happening to you is actually significantly higher than dying from a lot of pretty common illnesses.
      - michaelt 8y ago
        But you also have a significant risk to your life if your doctor can't get to them and orders the wrong treatment. Don't you think I'm in a better position to make that decision than a central government bureaucrat, given that I have my medical records and an incentive to protect my own privacy, and he has neither?
        jbob2000 8y ago
        It's not good public policy for millions of people to make individual decisions about this. It's expensive for the healthcare system when there are a million different ways for it to access your data; some people bring in papers, some papers are on the other side of the country, some people have a USB stick, oh granny lost hers in a fire here's a photocopy from 10 years ago. It's just much more effective to manage these things at scale. You have incentive to product your privacy, but you don't have the means. Are you going to bolt a fire-proof safe to your basement floor and keep a backup in a storage unit? Are you going to store them on a disconnected harddrive and create backups every 3-6-12 months? Can we expect every Australian to do this? Can we expect everyone to want to spend hundreds of dollars to make this happen?
        vertex-four 8y ago
        So in my country, records are kept by the individual clinics, where I have GDPR rights over them and there isn’t a direct mechanism by which anybody but the clinic can access them. If I move clinic, there’s a process by which those records get moved with my consent.
        jbob2000 8y ago
        Yep, works like this in Canada. The problem is that each clinic implements a different record system, so someone needs to undergo effort to translate them when you switch systems. Also, I worked with OSCAR, one of Canada's biggest EMRs. It is written by a bunch of academics at a local university and is individually deployed on under-the-desk computers at clinics. It is full of security holes, the whole process of managing this system is. I get why you want rights over the medical records. You can still have those on a centralized system. Google and facebook are centralized and you have rights over them (in some jurisdictions anyways).
  - pimmen 8y ago
    I agree. In the US, the equivalence of a packed Boeing 747 of people die every day because of medical mistakes. It's the third leading cause of death. If you could reduce that number by 1% through this policy, that would mean thousands of people saved every year. In my opinion, the risk-reward analysis is clearly in favor of a centralized system.
    - TheSpiceIsLife 8y ago
      That’s actually a Grady point. Thanks for raising it.
- shoo 8y ago
  ... or privatised and all the data used commercially
dav43 8y ago
I'm all for donating health record information for the greater good to universities and researches to analyse and progress science and knowledge etc. However, this government has no idea what is doing, the framework is poor, oversight is poor, without a doubt the implementation will be poor and its pulling a "swift on" on the public. Lets not forget, this is a government that couldn't handle an IT system thad a few million people filling out a census form online.
jazoom 8y ago
It's really not that much money as an incentive. Doctors won't do it unless they believe it's a good thing. Source: I'm an Australian doctor.
- TheSpiceIsLife 8y ago
  What are you doing, and what is your professional organisation (the AMA) doing, to counter long wait times for doctors visits?
  - jazoom 8y ago
    I dunno man. I'm not a member of the AMA and I've always run pretty well on time unless I get bowled a bouncer. I used to get frustrated with doctors running late, until I became one. It's the patients that come before you that largely determine how late the doctor is. If someone might be having an MI but only came in to discuss "reflux" the doctor is going to run behind. What would you do about it? Though, I'm not sure why you're asking me this since it has nothing to do with this thread.
  - RichEO 8y ago
    So much entitlement in this post Never the less, I’ll bite because this is a topic of interest to me. What kind of wait times are you talking about? Emergency room? Public non-emergent and elective surgery? Private practice specialists? Bulk billing or private billing general practice?
  - zanchey 8y ago
    You can have most stuff in Australian healthcare good, cheap or fast. Pick two.
- zanchey 8y ago
  Are you opting out? I keep remembering that AHPRA applied for warrantless access to metadata, and thinking that perhaps I might be better without a record in case the wideranging provisions for access by other agencies get deployed too liberally.
sorokod 8y ago
You can make the A) argument about any centralised database system. There is a down side and as always the challenge is finding the balance: the problems being solved Vs problems being added.

TheSpiceIsLife 8y ago

C) the database never gets hacked, or leaked, or otherwise exfiltrated

jopsen 8y ago
Even if there is a risk of this. It might be a risk worth taking. Edit: I don't know the specifics, but I sometimes wonder what good stats on more health records could do for future treatments.
- vertex-four 8y ago
  I wouldn’t intentionally place my health records out of my own control, because I have significant risk to my life if those records become public. Having certain illnesses and medical history is inherently political in 2018 - being trans can result in violence against you, talking to your doctor about STIs - even just prevention - can get you kicked out of your home, having medicated/treated schizophrenia will result in losing job/housing/etc opportunities. This isn’t going to change even if all those records become public in some way.
  - pimmen 8y ago
    But you also have a significant risk to your life if your doctor can't get to them and orders the wrong treatment. The risk of that happening to you is actually significantly higher than dying from a lot of pretty common illnesses.
    - michaelt 8y ago
      But you also have a significant risk to your life if your doctor can't get to them and orders the wrong treatment. Don't you think I'm in a better position to make that decision than a central government bureaucrat, given that I have my medical records and an incentive to protect my own privacy, and he has neither?
      - jbob2000 8y ago
        It's not good public policy for millions of people to make individual decisions about this. It's expensive for the healthcare system when there are a million different ways for it to access your data; some people bring in papers, some papers are on the other side of the country, some people have a USB stick, oh granny lost hers in a fire here's a photocopy from 10 years ago. It's just much more effective to manage these things at scale. You have incentive to product your privacy, but you don't have the means. Are you going to bolt a fire-proof safe to your basement floor and keep a backup in a storage unit? Are you going to store them on a disconnected harddrive and create backups every 3-6-12 months? Can we expect every Australian to do this? Can we expect everyone to want to spend hundreds of dollars to make this happen?
        vertex-four 8y ago
        So in my country, records are kept by the individual clinics, where I have GDPR rights over them and there isn’t a direct mechanism by which anybody but the clinic can access them. If I move clinic, there’s a process by which those records get moved with my consent.
        jbob2000 8y ago
        Yep, works like this in Canada. The problem is that each clinic implements a different record system, so someone needs to undergo effort to translate them when you switch systems. Also, I worked with OSCAR, one of Canada's biggest EMRs. It is written by a bunch of academics at a local university and is individually deployed on under-the-desk computers at clinics. It is full of security holes, the whole process of managing this system is. I get why you want rights over the medical records. You can still have those on a centralized system. Google and facebook are centralized and you have rights over them (in some jurisdictions anyways).
- pimmen 8y ago
  I agree. In the US, the equivalence of a packed Boeing 747 of people die every day because of medical mistakes. It's the third leading cause of death. If you could reduce that number by 1% through this policy, that would mean thousands of people saved every year. In my opinion, the risk-reward analysis is clearly in favor of a centralized system.
  - TheSpiceIsLife 8y ago
    That’s actually a Grady point. Thanks for raising it.
shoo 8y ago
... or privatised and all the data used commercially

dav43 8y ago

I'm all for donating health record information for the greater good to universities and researches to analyse and progress science and knowledge etc. However, this government has no idea what is doing, the framework is poor, oversight is poor, without a doubt the implementation will be poor and its pulling a "swift on" on the public. Lets not forget, this is a government that couldn't handle an IT system thad a few million people filling out a census form online.

jazoom 8y ago

It's really not that much money as an incentive. Doctors won't do it unless they believe it's a good thing. Source: I'm an Australian doctor.

TheSpiceIsLife 8y ago
What are you doing, and what is your professional organisation (the AMA) doing, to counter long wait times for doctors visits?
- jazoom 8y ago
  I dunno man. I'm not a member of the AMA and I've always run pretty well on time unless I get bowled a bouncer. I used to get frustrated with doctors running late, until I became one. It's the patients that come before you that largely determine how late the doctor is. If someone might be having an MI but only came in to discuss "reflux" the doctor is going to run behind. What would you do about it? Though, I'm not sure why you're asking me this since it has nothing to do with this thread.
- RichEO 8y ago
  So much entitlement in this post Never the less, I’ll bite because this is a topic of interest to me. What kind of wait times are you talking about? Emergency room? Public non-emergent and elective surgery? Private practice specialists? Bulk billing or private billing general practice?
- zanchey 8y ago
  You can have most stuff in Australian healthcare good, cheap or fast. Pick two.
zanchey 8y ago
Are you opting out? I keep remembering that AHPRA applied for warrantless access to metadata, and thinking that perhaps I might be better without a record in case the wideranging provisions for access by other agencies get deployed too liberally.

sorokod 8y ago

You can make the A) argument about any centralised database system. There is a down side and as always the challenge is finding the balance: the problems being solved Vs problems being added.