The following is an exerpt from a Blog published in the UK and describes an early experience with an online booking system that has been deployed in the UK to allow patients to book their own appointments for services. It is an interesting example of the impractical nature of systems change. This will be something that the remainder of the world will be watching carefully.
"Is Choose & Book, the new system for getting hospital appointments any good? In a word, “no”. In more words “well, not based on my experience, though that may just be teething problems.” In many more words, and a few screenshots: .... In pursuit of this goal, I have had my first encounter with NHS Choose & Book. The GP needed to refer me to an audiology unit for a hearing test. Choose & Book presented my GP with three choices:" Link: NHS Choose & Book: no appointments, no waiting list, no NHS..
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This piece is very worrying and reflects the concerns of many GPs in the UK.
- Centralised systems nearly always compromise privacy/confidentiality
- medical confidentiality should be physician driven - it is too important to leave to governments and Health Authorities - and no-one understands medical confidentiality better that family physicians
- general privacy legislation should not be the measuring stick for judging medical confidentiality
Let us hope that the medical colleges grasp this nettle, and soon. To date we have seen the College in BC supporting a chronic disease management toolkit that required the sending of identifiable patient data to government servers.
Traditionally patients have not been the custodians of, but have had considerable control over, their medical information. If a patient chooses to share something in the privacy of a consulting room, that information has been charted and kept in that office and has only been shared when that patient is referred to another physician (or health care provider). Many of us share the contents of the referral letter with the patient before it is sent (EMRs facilitate this).
Electronic information sharing systems are superficially great, but we need to look closer and see what else they are doing to the culture of medicine and what we might risk losing if we don't pay close attention.
Our systems of information sharing have evolved over hundreds of years. We should build electronic tools to fit these systems and not build systems and then say 'oops, now how do we make this fit a confidentiality model'.
Patient consent via a poster in the institution that they are seen in, often when they are sick and need the help of that institution, is _not_ adequate consent for the sharing of their information in perpetuity.
Our office just had a letter from the BC Cancer Agency seeking permission from one of the docs to contact a patient of ours who has cancer. Presumably the patient is on some sort of disease register at the BCCA. This was queried and we asked specifically if the patient had consented to be on the register and had pro-actively agreed to be part of surveys etc. We were told 'no' but it is just part of what the BCCA does. If this is the case then. I submit, this is not adequate attention to privacy and consent issues.
Beware of those who say they are building systems with privacy running as a thread from the first day of construction. The last time I heard this said, the presentation was quicly followed by a tool that the organisation had developed, that by their own admission had significant privacy issues but when asked if they had therefore discontinued the pilot, the answer was 'no'......
Erosion of medical confidentiality is likely one of the current main enemies of good medical practice. I hope we can fight to preserve it whilst embracing EMRs and other great electronic tools.
Jel Coward
Pemberton, BC
EMR user since the early 90's
Posted by: Jel Coward | February 14, 2006 at 09:01 AM
This is also worth a read.
http://tinyurl.com/bgkxg
Jel
Posted by: Jel Coward | February 17, 2006 at 03:41 PM