So you think that a country that can put pig genes in people could do filing correctly right?
Wrong.
As myself, The Ex-Expat, and some people in the DomPost can attest, the problem of very poorly integrated medical records is a very real one for New Zealanders. As it stands there is so little integration that I’m often required to wait for months for records to be transferred between hospitals, it even takes a month for a record to travel within Wellington Hospital, and I keep my own log so that I can easily remember when different events occur.
Basically, the system doesn’t work. Information transfer in “the medical system” is a joke, and “customers” (or what they used to call patients) are all too frequently let down. It has been my extremely good luck to have an uncle who is a cardiologist and is able to collate all the relevant facts and give me something like a useful summary of where my health is at (side note: health not so bad, just some unusual physiology that makes life difficult sometimes).
Recognising that the system doesn’t work, and that making it work is a Sisyphean task that could bankrupt the nation, we need a cheap and reliable* solution. Also, health policy doesn’t seem to be on the radar for this election, so I think I can chat away safely. If it does become discussed in the next few days, then, well, I guess I’m just an originator.
I can’t take credit for this idea, but what Dave Snowden said has been applied in [insert country here] is that medical records are transferred for safe-keeping to the real owner of those records, the patient. The basis of this idea is relatively simple, the person who has the greatest interest in the health and well-being of the patient is… the patient. Consequently the safest place for medical records is with that person. The trick of course is how to get the records across, and how to keep them safe.
There are three issues in there. First of all is the problem of loss of records. If the individual loses their records then all the records could be lost!! But actually, no. Because all the records would remain with the various health providers. All the individual does is compile copies of all their own records, so if they lose them, they can just go back to all the providers and recollect them. A hassle, but an incentive to keep an eye on them.
The second issue is the technology. Which is a very real issue. Different providers use different systems, and there are lots of different things you need to keep. So what happens to all the”stuff” and how do you keep it in a useable format?
To be honest, I dunno. There will be some tricky stuff in there, and this is likely the only actual issue. But, many records could easily be kept in PDF to prevent them being tampered with, and advances in technology mean that it’s easy for people to purchase gigabytes of thumb drive to store stuff on.
The third issue is privacy. What if someone finds and exploits your records!! Well… keep them safe the same way you would any valuable. What about, “people seeing what medical professionals write on their records!!” Well [again]… medical professionals generally don’t write nasty notes on your records. If they do, then that is another issue altogether. A more pressing issue is people having access to both their own records and the internet. Self-diagnosis is probably the worst outcome of this idea.
Expanding the idea, you could also encourage people to use services like LifeBox to store their personal data.
In the end, what this approach for someone like me is that I wouldn’t have to worry about turning up to an appointment and have a specialist tell me that everything is hunky-dory when I was only in emergency a few days before. I could also transport my records to a new GP, which I needed to recently. In short, a win for everyone. Cheap for the public health system, and more reliable for patients.
*Not guaranteed to be reliable.
21 October, 2008 at 7:08 pm
I have a specialist appointment in a few weeks to discuss surgery to remove a (hopefully) benign tumour following a recent MRI. The thing is we will very soon be moving to Dunedin. I am in terror of my records and stuff being lost when I go down and not getting this thing seen to. Because of your and the ex-expats experiences I will be taking copies of ALL my records and results with me as well as requesting a covering letter from the specialist. I will ask them to contact Dunedin directly as well but I don’t hold much hope for that
21 October, 2008 at 7:29 pm
You seen what Google Health (https://www.google.com/health) is doing (for US patients only) – this is their blurb:
—–
Google Health puts you in charge of your health information. It’s safe, secure, and free.
* Organize your health information all in one place
* Gather your medical records from doctors, hospitals, and pharmacies
* Keep your doctors up-to-date about your health
* Be more informed about important health issues
Google stores your information securely and privately. We will never sell your data. You are in control. You choose what you want to share and what you want to keep private.
21 October, 2008 at 11:18 pm
Dude, that image is 1.2MB! WTF! Please resize it rather than just scaling it down. It’s cruel for your visitors, some of whom have data caps.
22 October, 2008 at 6:36 am
Lots of this stuff has been discussed in the Guardian over the last few years as a quick google will reveal. Being Britain, of course this has involved a state that doesn’t care about the authoritarian abuse of patient confidentiality, vast overspends on IT programmes and failure to deliver promised benefits.
Maybe one of the questions that could be asked at this election is if both parties are finally getting serious about broadband in NZ, could they commit to enabling free medical use of these pipes to transfer patient data around, thereby taking one of the cost elements out of the equation.
22 October, 2008 at 7:36 am
@ROBYN. PHOTO FIXED. BUT… HEY, WHO HAS A DATA CAP THAT SMALL THESE DAYS?
@MIKE. SURE, BUT TWO WORDS. CREEPY TREEHOUSE.
@ART FYI. IT’S INTERNATIONAL CAPS LOCK DAY. NOT JUST SHOUTING. GOOD LUCK WITH THE RECORDS. JUST BE THOROUGH AND DON’T TAKE “NO, U CAN’T HAVE THEM” FOR AN ANSWER.
22 October, 2008 at 8:22 pm
Intrigued by the LifeBox suggestion, except you seem to be linking to the blog of somebody who just got engaged in Italy (a capital idea in and of itself, but still…).
23 October, 2008 at 5:51 am
yeah, that’s the development site i think? i haven’t been able to find the “sales” site.
23 October, 2008 at 9:39 am
Obviously a hot topic if Microsoft are also in the game with Google. (http://www.healthvault.com/)
Good luck to anyone taking both of them on! (Though it would be great to see a NZ version covered by our laws.)
23 October, 2008 at 12:33 pm
my current hospital favourite
the hospital dietitian ringing a week after my fathers death to discuss what supplements they need to order so we could have him home.
He’d been home 2 weeks before he died
but i will say this god bless the nurses in the hospital system. they know more about what their patients actually need than doctors
23 October, 2008 at 6:11 pm
jesus… sorry to hear that sue. i hope she was appropriately shamed.
wellington hospital is a freaking joke.
26 October, 2008 at 9:07 pm
“…how do you keep it in a useable format?”
With the move towards computerised record keeping this is quite an issue and an issue that’s a bit invisible.
Most health database software (that I know of) is essentially based on software designed for business. And it works for business.
But how do you organise information about someone’s health in such a way that it makes pulling out and correlating relevant information intuitive and simple? That’s not an issue that appears to be being considered in the development of health software that I’ve had experience with.
What business database software can do very well is generate forms. That means that the software in the health system is also very good at generating forms. But because it’s so easy people start to think that having more forms means something in terms of efficiency. But it often doesn’t – health staff just get to fill out more forms. Whenever something bad happens the reaction is often – we’ll fix it with more forms.
Anyway, from talking to various computer people one possible solution would be via object-orientated programming which is much more expensive. It’s mostly used in gaming – where there’s a need to store information about characters. Not unlike what computerised health records are supposed to do.
(as an aside – how efficient can any record system be?)
3 November, 2008 at 6:45 pm
I used to work in medical records at Wellington Hospital and know quite a lot about medical information. There actually is a centralized database which doesn’t hold all of your paper records, but does hold all your lab results, radiology reports, outpatient letters and discharge summaries (a report of each in patient admission which summarizes diagnoses made and procedures performed) produced in the public system. Copies of most of these are also given to inpatients as they are discharged. This does not always happen in the case of the emergency department because there often hasn’t been time to do the paperwork before discharge. In this case you are entitled to ask for copies to be mailed to you. The database is linked to your NHI number and is available nationally. Your cardiologist has access to it and should have been able to use it. In addition, the cardiology department maintain their own, duplicate, files for their patients. When I last worked there (five years ago) the cardiology department in particular had a culture of blaming admin staff for their own lack of organisation.
It is true that is in the past, medical records were often disorganised and inefficent, but this has hugely improved in the last few years with a new computer system, and in reality, 99% of files are where they should be, when they should be. Also, there are regular courier deliveries between hospitals (twice a day to the Hutt and Keneperu) and generally speaking, there is no problem tranferring records quickly via fax to hospitals further afield. There has to be, sometimes it literally life or death, not just a matter of convenience. (this does not always apply to records from the private system, who do not generally share results with the public system as a matter of course – this a problem with a dual public/private health system, and patients are explicitly told in their appointment letter to bring any private test results with them to the hospital.)
Effectively, what you are suggesting is what is already happening – Patients can and should have copies of their own records are actively encouraged to bring them to appointments, and the most important information is centrally available. The porblems lie when paperwork gets behind and doesn’t keep up with events, when the private system doesn’t interact properly with the public system, but mostly when individuals do not use the system properly. This will always be factor in the entrenched low morale and conservative culture of a public hospital, however the system is tinkered with.
I want to make the point that the administration staff at the hospital are not incompetent or inefficient, and work just as hard to look after patients as the clinical staff, but with low pay and little support. As with any system in a large organisation, it is only as good as people are willing to make it, and is subject to human error, but in this case much less than anecdotal evidence would suggest.
4 November, 2008 at 7:52 am
thanks alice,
i should point out that i’ve *never* been issued with records by emergency unless i specifically ask for them.
i sympathise with the low pay/poor conditions argument of the records team though. it seems to be the case in most places.
9 November, 2008 at 8:24 pm
Just wanted to add that at a hospital visit last week the records people coudln’t have been more awesome and my faith in the NZ health system has been fortified by the fact that when things need to happen fast then it really is all on. My appointment was midday Friday and all necessary documentation and forms to fill out arrived in my mail box Saturday morning. Surgery in a week!