Have paper records passed their expiry date? CMAJ Sep 2005

Read full article here.

"The manager of your local grocery store can instantly determine how many kilos of Ida Red apples are still on the shelves, the use-before dates of every carton of soy milk, the total cash in the cash registers and the dollar value of unsold loaves of bread that will be distributed that evening to the local food bank. Her best friend, a doctor, doesn't know that the elderly patient in his office had a chest x-ray last night when he visited the emergency department, what laboratory tests were ordered — let alone the results — or the type and dose of prescribed medications, if any. His patient remembers having an x-ray, but doesn't know the results. He is foggy about the tests and the meds. Neither patient nor doctor knows the date of the patient's last cardiology consultation or recalls off-hand whether he received influenza and pneumococcal vaccines last year. The clinical encounter grinds to a halt while the doctor thumbs through a bulging paper file of barely legible notes."

Possible developments for network access at TBRHSC.

Currently, IT installs software on our computers (ZENworks for Desktops 4) so we can access Novell delivered services securely. This means that we are limited to using IT approved hardware and software installations that is tightly, and understandably, controlled for security reasons.

We can use our own hardware and operating systems however, if we connect using Citrix access. The only software you need is the Citrix client (now called Citrix XenApp, formerly known as Presentation Server). We still need IT to configure wireless access for us, as the encryption key is confidential for security reasons. This can be a pain if you want to use another computer that hasn't been pre-configured, of if your wireless key gets wiped out somehow.

A third way that is being explored, is to have "open" or "unsecured" wireless access available on site so any computer can access the wireless network. To proceed to access Citrix and Novell services however, physicians would have to go through a web based logon screen using our current Novell passwords.

No IT setup required. No new passwords to remember. Total freedom to use whatever hardware and operating system you want.

Nice!

Getting to the electronic medical record - CMAJ Feb 2008

"In the beginning, the record was simply a retrospective account of what transpired at each encounter between the physician and the patient. At the subsequent visit, it served as an aide-mémoire. Over time, one or more threads would run through it, more or less synthesized into a linear account of any particular illness. Soon though, hospital discharge summaries, attempts at treatment and, later on, laboratory test results were added in. Practice partners added interim notes, consultation letters began to arrive, followed by paramedical opinions, insurance reports and so on. Then specialization led to distinct records being kept in separate offices.

Soon, communication between holders of records became irregular. Bits of information came to be acquired in many places at different times, without a consistent means to unify them into a coherent whole. Information was being gained, but knowledge was being lost. Eventually, no one blind man could probe and adequately describe the proverbial elephant."

The entire original article is here.

Letters to the editor are here and here.