Hi Karsten,
Comments in text.
Regards!
-Thomas Clark
Karsten Hilbert wrote:
"That is not feasible"
And that's the problem that will keep the technical people in money for
years to come.
I am not a technical person per se. I am an clinician.
Not only must it be feasible it will be demanded by judges
and courts
Surely, courts and judges have been known to demand and
accepts proofs that aren't proofs before. They'll learn, too,
what things need to be taken to mean.
Legal systems tend to be autonomous in the sense that the remainder of society must
conform to the laws and Judicial interpretations thereof. They tend to rely upon prior
interpretations and modifications to the law and demand that suggestions for change be
substantiated beyond 'some' unpublished standards, e.g., genetics is provable since it
is consistently reproducible beyond statistical norms while 'Lie Detectors' are still
struggling.
Courts are not likely to be interested in learning about EHRs other than how to use
them in related cases as evidence that supports or defeats positions. EHRs supply
content, which can be taken out-of-context and which suffers from the common
maladies, inconsistent, incomplete, etc. In this way they are very similar to paper
records, i.e., Taken together, what do they convey to the Court.
Whatever legal problems the Healthcare Industry now has with paper records may
remain with EHRs, and some new ones may be created due to the new technology,
e.g., a paper record can be locked up in your Safe Record Repository, an EHR can
be archived on the Internet and available to Hackers.
if the EHR is to ever be truly adopted.
Too pessimistic, IMO.
The EHR will be adopted and hopefully Legislatures will make new, appropriate law.
Even now we have rules
that all e-mails where a decision is made must be printed out!
Which is akin to photographing every screen you view.
If the content is crucial then make a record of it.
The paperless world has never been to court.
In a court one not always has to provide a waterproof trail of
evidence. There is "substantial evidence" (is that what it's
called ?). And there is "demonstration of due course" which
adds a lot of weight to what otherwise are simple assertions.
Admissible "Substantial evidence" permits inference and deduction while admissible
evidence of a "course of conduct" for an individual, an association or an industry can be
used for a variety of purposes to 'tip the scales', EHRs may well be viewed as being
more 'form' than 'function', i.e., the content is similar to that derived from paper records.
It is feasible of course but complex. Flags are set when pages are viewed,
Those flags do not document what you want them to document.
Such a flag only documents that it was set. Everything else is
"due course". Eg. if the flag is set "it is reasonable to
assume" that it was set by the software the doctor claims to
have used. Also "it is reasonable to assume" that the doctor
thus "saw" what that program would display in conjunction with
that flag being set. No hard proof there.
Flags are a problem and can be subject to multiple interpretations.