Hi All, With a background in fault tolerant computing I have a built-in penchant for distributed files that are exact/backup copies of a master. Works wonders for financial transactions.
I don't believe that this model fits EHRs especially since one can conceive of parallel, e.g., close proximity in time, operations directed at modifications originating at geographically distant locations.These operations, even they occur across town (Clinic and distant Lab) create problems for record management. Tying record management to physical location is not a solution. Remote medicine complicates this immediately. However, a constant occurs immediately, presuming that we do not have to deal with human clones (put a <dash-number> in the ID). The Patient ID is it. Traditional approaches would require that in all the world there is only one unique person being considered. (hopefully). Hence each region could contain entries on residents, transients, visitors. tourists, etc. that somehow make contact with healthcare facilities/Practitioners in the region. Registering the IDs and updating the regional databases requires that only those regional Patients be administered. National and international databases can be established that will receive and store regional registrations of Patient IDs, allowing one to scan these databases to determine who holds regional records on individual Patients. One can then retrieve all the records or part of them. This substantially reduces the need for storage and bandwidth to manage records on a global scale. I presume that there is no need to have matching records for individual Patients in all regions this Patient has been in an made contact with the healthcare industry. If I take a cruise on the Rhine and require medical attention it makes no sense to burden whatever region manages that healthcare system with anything more than they had a tourist with a weak stomach. It would be nice to have a distributed registry that would show where I had to stop off and get some help. At least the Public Health personnel would appreciate it. The important thing to me is to be able to access all the known records and bundle them in a way that is appropriate for the healthcare personnel handling my latest complaints. BTW: The Fault Tolerant/Highly Available Systems can make sure that the information requested is available but the applications have to structure it. -Thomas Clark - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
