Proving the concept of a data broker as an emergent alternative to supra-enterprise EPR systems

Electronic Patient Records systems configured into large enterprise models have become the assumed best route forward. In England, as in several other countries, this has expanded to a major meta-enterprise procurement programme. However, concerns are raised that such systems lack user ownership, and experience from other sectors shows difficulties with large enterprise systems. At a time of great change and once again shifting organizations, is this move simply building large and ponderous edifices with unstable materials? Latest software engineering research is now demonstrating the potential of an alternative model, enabling trusted information brokers to search out in real time at point of use data held in registered local and departmental systems. If successful, this could enable a new and less cumbersome paradigm. The data could move where needed whatever the service configuration. A concept demonstrator has been built set in the context of health and social care in England. It is important for all technological support to the health sector to be reviewed as new technologies emerge so as to identify and exploit new opportunities, and the results of this 3 year project show that the health record information broker route merits further investigative research.

From bridges to super-highways: transmitting meaning within and between professions, and across time and space--beginning the process

As development of health informatics, including electronic patient records, proceeds apace there is an innate tendency to focus on acute and primary care, and upon bio-pathological data sets. This is where virtually all research and investment is being directed. However, the core purpose of health care (and mental health care in particular) is to improve and maintain the individual's functioning and sense of well-being, not simply to eliminate adverse pathology. It is therefore vital for health care records to contain subjective, descriptive, and self-expressed components if the record is to have true health meaning. This in turn raises challenges about meaning and context, terms and language. Most informatic systems run the risk of being Islands of Automation, linked at best by bridges conveying data sets rather than knowledge. If health informatics is really to serve people and their health, attention needs to be given to developing the recording, communication, and understanding of perception through shared meaning. Only then will informatics systems be full supporters of the people's health, and record system linkages become Super-Highways of Knowledge between patients and their supporting professionals.

Building healthcare delivery and management systems centred on information about the human aspects

The importance of modern information systems to manage healthcare delivery at the macro level--particularly through purchasing--is increasingly being recognised. There is also increasing investment in electronic patient record systems to aid care delivery. Both are intended to benefit the individual, yet neither gives full consideration to the human aspects and values--largely because of the under development of appropriate terms and structures. It is important to identify and structure the human facets as the determinants and principal components of healthcare delivery systems, to improve the information structure of these components, and then to use them as the building blocks of macro-management systems, so as to fuel the whole dynamic with one set of person-based values.

Objectives and prerequisites to success for integrated patient records

The concept of integrated patient-based records at first sight looks logical and consumer orientated, but it cuts across traditional record-keeping practice. This paper draws from four different fruitful initiatives to identify benefits and success prerequisites.

A networked patient-based integrated care system as a basis for the achievement of quality in practice

Traditionally, telematics initiatives have mainly been used to link patients with specific conditions to monitoring services located in acute hospitals. However, latest application of telematics to the networking of integrated electronic records for ambulatory or community care has great potential to measure and assure the quality of health care delivery to a large sector of the population in a structured and comprehensive way. This paper categorizes the major quality opportunities of a pioneering initiative now achieving operational status.

Lessons from a child health system on opportunities and threats to quality from networked record systems

The British Child Health System has been designed and widely implemented to support equity of access to preventive child health services, using case-based integrated records. Lately, telematics has been increasingly applied to improve the timeliness of data entry. A special project has been established to monitor overall quality of the system's use and of the resultant preventive services. The telematics application has been found to be a potential threat to quality in a way which would apply to all remote networked patient-based systems. The demonstration will show the methodology and interim results.

Child health--a time for better understanding?

The importance of community and preventive child health services is generally recognized, but the questions raised about the delivery of these services are jeopardizing their development. The sequelae to the Court report have clouded the future for clinical medical officers; there are arguments about the relationship between general practitioners and the community services, whose management in turn may be reduced by NHS restructuring; while the debate about computer systems has caused further acrimony. However, an analysis of basic objectives and methods shows no valid ground for conflict, and instead all that is needed is agreement on how to implement the most efficient pattern of prevention for the benefit of all children.

A trial speech screening test for school entrants

An objective, low-cost means of screening school entrant children for speech disorders was designed, and speech therapists evaluated the doctor's screening results. In a field trial comprising 438 children, an accuracy rate of 92% was reported, with a referral rate by doctors of 14%, and speech therapists subsequently observing or treating 10%. The trial showed also the effects on accuracy rates of setting different pass levels.