6 ms·

Decades ago one of my first jobs was as an IT bod for a regional health service. One of their facilities was an family psychiatry centre. The staff there refu

Decades ago one of my first jobs was as an IT bod for a regional health service. One of their facilities was an family psychiatry centre. The staff there refused to let their records be held centrally, and instead had everything on clunky PCs bolted into lockable safes in the corner of each doctor's office. When the safe opened the keyboard slid out. The doctor in charge had also built their own database that they used. Early adopters, before the rest of the health service was modernizing with newfangled computer thingies. Clever people, those doctors.

heavenlyblue 6y ago
Another option is to go live in a forest and not use any of the digital tech at all. But that isn’t a smart solution if you’re doing all of this only not to get hacked. PS: let’s say a patient in that clinic wanted to move their history to another clinic. Are they now supposed to pro-rata their surgeon just to get the information from that custom-built database? That is incredibly expensive; and no matter how smart that surgeon is that database is almost certainly not that much more secure than off-the-shelf solution.
- ChrisMarshallNY 6y ago
  In the US, that's actually the way it works. HIPAA laws are very strict. When I change doctors, I have to go around to all my prior physicians, and get hand-signed releases delivered (if I'm lucky, they will accept a fax). Sometimes, the records are physical papers. I still have all my old MRI and CAT pics (long story).
  - 52-6F-62 6y ago
    With MyChart it's fairly simple to get health care summaries here in Canada (Toronto at least), but I still have to go t through the rigamarole for my images and getting them around to other caretakers. I should have done that last week actually...
    - treeman79 6y ago
      Print outs from my hats is not sufficient for disability cases.
      - 52-6F-62 6y ago
        Wasn't aware of this. Thankfully I haven't needed mine for that, just mainly keeping doctors abreast of other treatments and assessments, in summary.
    - deleted 6y ago
      [deleted]
  - treeman79 6y ago
    Down side is some years ago I got badly injured. I was unable to get my own records. I was not mentally competent during it, and I could not get assistance. So I failed to get disability, even though I had excellent coverage. Eventually recovered, have a ton of notes and instructions in place on who to talk to and how to gather all the correct documents in case of a future episode.
    - ChrisMarshallNY 6y ago
      Hope that you have been able to recover. Been there. Done that. Got the T-shirt (see "MRIs and CAT Scans," above).
  - toomanybeersies 6y ago
    On the other hand, the Australian government decided to create a system called "My Health Record", which centralises all your medical information. Luckily it's possible to opt-out, because there is absolutely no way I trust the Australian government to keep my personal data safe.
- jermaustin1 6y ago
  As the husband of a Marriage and Family Therapist operating in NYC and upstate, I can tell you that most client notes are still done on paper, and locked away. My wife's notes are either locked in a "safe" at her office (heavy time-locked door to a room, with locking file cabinets) in the city, or in a small locking fire-proof file safe at home. Really the only things that get computerized are the things required by insurance (diagnosis and treatment plans). But notes are highly personal to the therapist, and can include any number of on-topic or off-topic , and it is rare even under subpoena to release your personal notes. Her office has a lawyer on retainer who's only job is to quash subpoenas. She's never had one served to her, and I dont know if any of the other clinicians have. But back on topic - though, I'm 90% sure the clinicians at the psychotherapy clinic in GP's comment probably had the same thing. They would take paper notes, and only digitized what they needed to digitize, and most of those digitized records are non-transferable anyway, because they would be diagnosis and treatments for that patient/client provided by that clinic, and if a clinician left, and was allowed to take clients/patients to their new practice (sometimes allowed, but often times not), the clinician would take their personal notes with them.
  - mattr47 6y ago
    All MH notes are now digital for the US Department of Veterans Affairs and Department of Defense.
    - jermaustin1 6y ago
      I'm guessing in practice that translates to MUCH less notes.
Bukhmanizer 6y ago
IMO this is terrible advice. What happens after a decade when some or all of the desktops are way out of date? Are the doctors diligent about patching them? All of the doctors? Likely the situation they’ll end up in is a bunch of old computers running outdated software that all ends up being a massive security threat. Let’s say in 2005 one of the doctors wanted to video chat with their kid, and the kid tells them to download teamviewer. Chances are, 15 years later in 2020, that 2005 version of teamviewer is still going to be on that computer. I know this because I work in a psychiatric research institute (though not in IT) and this kind of stuff happens all the time. It’s not everyone, but in this case the weakest link breaks the chain.
- mschuster91 6y ago
  > Are the doctors diligent about patching them? Why should they be, if the system is airgapped?
  - jasonjayr 6y ago
    Not only airgapped, but it sounds like they were physically locked up when the Dr was not present. If they had full disk encryption too, that sounds like a pretty good solution for running old hardware securely.
- metalliqaz 6y ago
  sounds like the PCs were air gapped
- willvarfar 6y ago
  I wasn’t recommending something, I was describing it! This was before the internet. The very real threat were people trying to locate young victims taken into care etc. The center, on their own initiate, mitigated this by physically locking the computers into safes. They also used classic usernames and passwords, but I don’t think encrypted storage was a thing then.
  - Bukhmanizer 6y ago

heavenlyblue 6y ago

Another option is to go live in a forest and not use any of the digital tech at all. But that isn’t a smart solution if you’re doing all of this only not to get hacked. PS: let’s say a patient in that clinic wanted to move their history to another clinic. Are they now supposed to pro-rata their surgeon just to get the information from that custom-built database? That is incredibly expensive; and no matter how smart that surgeon is that database is almost certainly not that much more secure than off-the-shelf solution.

ChrisMarshallNY 6y ago
In the US, that's actually the way it works. HIPAA laws are very strict. When I change doctors, I have to go around to all my prior physicians, and get hand-signed releases delivered (if I'm lucky, they will accept a fax). Sometimes, the records are physical papers. I still have all my old MRI and CAT pics (long story).
- 52-6F-62 6y ago
  With MyChart it's fairly simple to get health care summaries here in Canada (Toronto at least), but I still have to go t through the rigamarole for my images and getting them around to other caretakers. I should have done that last week actually...
  - treeman79 6y ago
    Print outs from my hats is not sufficient for disability cases.
    - 52-6F-62 6y ago
      Wasn't aware of this. Thankfully I haven't needed mine for that, just mainly keeping doctors abreast of other treatments and assessments, in summary.
  - deleted 6y ago
    [deleted]
- treeman79 6y ago
  Down side is some years ago I got badly injured. I was unable to get my own records. I was not mentally competent during it, and I could not get assistance. So I failed to get disability, even though I had excellent coverage. Eventually recovered, have a ton of notes and instructions in place on who to talk to and how to gather all the correct documents in case of a future episode.
  - ChrisMarshallNY 6y ago
    Hope that you have been able to recover. Been there. Done that. Got the T-shirt (see "MRIs and CAT Scans," above).
- toomanybeersies 6y ago
  On the other hand, the Australian government decided to create a system called "My Health Record", which centralises all your medical information. Luckily it's possible to opt-out, because there is absolutely no way I trust the Australian government to keep my personal data safe.
jermaustin1 6y ago
As the husband of a Marriage and Family Therapist operating in NYC and upstate, I can tell you that most client notes are still done on paper, and locked away. My wife's notes are either locked in a "safe" at her office (heavy time-locked door to a room, with locking file cabinets) in the city, or in a small locking fire-proof file safe at home. Really the only things that get computerized are the things required by insurance (diagnosis and treatment plans). But notes are highly personal to the therapist, and can include any number of on-topic or off-topic , and it is rare even under subpoena to release your personal notes. Her office has a lawyer on retainer who's only job is to quash subpoenas. She's never had one served to her, and I dont know if any of the other clinicians have. But back on topic - though, I'm 90% sure the clinicians at the psychotherapy clinic in GP's comment probably had the same thing. They would take paper notes, and only digitized what they needed to digitize, and most of those digitized records are non-transferable anyway, because they would be diagnosis and treatments for that patient/client provided by that clinic, and if a clinician left, and was allowed to take clients/patients to their new practice (sometimes allowed, but often times not), the clinician would take their personal notes with them.
- mattr47 6y ago
  All MH notes are now digital for the US Department of Veterans Affairs and Department of Defense.
  - jermaustin1 6y ago
    I'm guessing in practice that translates to MUCH less notes.

Bukhmanizer 6y ago

IMO this is terrible advice. What happens after a decade when some or all of the desktops are way out of date? Are the doctors diligent about patching them? All of the doctors? Likely the situation they’ll end up in is a bunch of old computers running outdated software that all ends up being a massive security threat. Let’s say in 2005 one of the doctors wanted to video chat with their kid, and the kid tells them to download teamviewer. Chances are, 15 years later in 2020, that 2005 version of teamviewer is still going to be on that computer. I know this because I work in a psychiatric research institute (though not in IT) and this kind of stuff happens all the time. It’s not everyone, but in this case the weakest link breaks the chain.

mschuster91 6y ago
> Are the doctors diligent about patching them? Why should they be, if the system is airgapped?
- jasonjayr 6y ago
  Not only airgapped, but it sounds like they were physically locked up when the Dr was not present. If they had full disk encryption too, that sounds like a pretty good solution for running old hardware securely.
metalliqaz 6y ago
sounds like the PCs were air gapped
willvarfar 6y ago
I wasn’t recommending something, I was describing it! This was before the internet. The very real threat were people trying to locate young victims taken into care etc. The center, on their own initiate, mitigated this by physically locking the computers into safes. They also used classic usernames and passwords, but I don’t think encrypted storage was a thing then.
- Bukhmanizer 6y ago