Medical records and the Cloud

Computer illiterates will not know that the Cloud is the place where you can store your data without requiring it to be on some unreliable hard disk in a desktop computer. Basically it is a global collection of servers; your stuff could, in truth, be anywhere, and that is what has, perhaps, underpinned opposition to the development of an electronic patient record (EPR) system for the NHS (along with the fear that someone inappropriate will nick the data and find out you have AIDS, thereby changing your chances of getting life insurance).

I don’t personally have much of a problem with this (and no, I don’t have AIDS, although I did once perform a procedure on a colleague who had failed to reveal he was HIV-positive). In fact I use a secure service to keep my correspondence there, so I can access it at will from one of the sites I work at. After all, vast amounts of data on you are already held by your bank or banks, mortgage lender, financial adviser, Ebay, Amazon and any other retailer from whom you have bought online. It’s spooky, even knowing that, when you get emails suggesting things you should buy which are based on past purchases. It’s even more spooky when you discover that your car insurance renewal date appears to be common knowledge among all car insurers, and a dozen or so letters turn up suggesting you might like to consider switching. (I did actually pursue one such quote, which turned out to be uncompetitive, and then gave reams of personal information so they could quote for my house insurance also, only to find that the level of contents cover I had was several times their maximum.)

Medical data is fragmented. Your GP has some, maybe almost all. The various hospitals you have attended will have more. You may yourself have copies of letters about you, and a repeat prescription list. But it is very irritating for physicians to meet a patient for the first time and find that a vast swathe of necessary information is unavailable to them.

When my hospital merged with two others there was the devil’s own job trying to marry up the different IT systems and databases. It was 18 months before I could view X-rays and scans done on the other sites, so the best way to provide a one-stop service was to repeat the investigation. Not cheap[1], and not terribly good for the patient.

Perhaps the answer lies in the data stick. Everyone who has a computer, near enough, will have one (or more – I have about 12 – they appear as conference freebies) or seen one. They can be encrypted. So let’s give every patient a personal stick on which can go all their medical history, drug list, allergies, correspondence, investigation results etc. USB sticks are big enough nowadays. The patient can present it at their next consultation, the health professional can plug it in, enter a password and get access (perhaps even at different levels). Simples!

Of course, there will be much blathering about what happens if you lose your stick, it gets flushed down the loo, eaten by the dog (don’t laugh – when I was in the mobile phone shop a lady came in with a terminally chewed BlackBerry and mournfully reported that this was the fourth the dog had ruined) or run over by a lorry. Listening to the hysteria there has been over the EPR you would believe the world would come to an end. So why don’t people have the same approach to credit cards? Everyone has lost one or had one stolen, or knows someone who has. You might even have your bank account emptied. But the general reaction is to shrug shoulders and say “It happens”. What’s so special about a medical data stick? The plus side is you will never again encounter a doctor rolling the eyes heavenwards and bewailing his lack of information – or the missing notes.

Electronic communication is now the norm. We have emails, text messages, Twitter, Facebook and others. So why does communication between GP and hospital consultant interpose a raft of paper?

My secretary types a letter from a tape I have dictated and stores it on her computer. She then prints a copy, stuffs it in an envelope and sends it to the GP. The GP staff open it, scan it into their computer and shred the hard copy.

Let’s cut out the middle man, and email the letter. No paper, no post, no delay (indeed it would be even better with voice recognition software, so we could do away with the tapes, which always get scrunched up or separated from the pile of notes they refer to – but the last time I tried this the program wouldn’t recognise methotrexate and kept printing “me though treks eight” however hard I tried to train the bloody thing).

Oh no. Blather, blather, the internet isn’t secure, confidential things could go to the wrong people etc. As if the postman delivers everything to the right address, assuming they deliver it at all…


[1] The cost of integrating all systems in S London Healthcare Trust was put at £12m – which, as it had a deficit at the time of around £40m, was not exactly affordable.


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