A patient's medical records are generally fragmented across multiple treatment sites, posing an obstacle to clinical care, research, and public health efforts. Electronic medical records and the internet provide a technical infrastructure on which to build longitudinal medical records that can be integrated across sites of care. Choices about the structure and ownership of these records will have profound impact on the accessibility and privacy of patient information. Already, alarming trends are apparent as proprietary online medical record systems are developed and deployed. The technology promising to unify the currently disparate pieces of a patient's medical record may actually threaten the accessibility of the information and compromise patients' privacy. In this article we propose two doctrines and six desirable characteristics to guide the development of online medical record systems.
Some of the stresses on the doctor-patient relationship could be eased by using computerized and internet based tools for decision support, communications, and documentation, like IS&T. As medical care increasingly depends on computerization, software engineering and marketing practices become more relevant to issues of healthcare delivery and patients' rights (Hodge, 1999). Unfortunately, many current systems fragment medical records by using incompatible means of acquiring, processing, storing, and communicating data. These incompatibilities may result from a failure to recognize the need for interoperability or they may be deliberate, with the aim of locking consumers into using a particular system. Either way, the practice precludes sharing of data across different applications and institutions (Computer Science and Telecommunications Board, 2000).
The alternative to proprietary methods is the use of open standards. At minimum, open standards should be used in the exchange of information among different systems. For example, HL7 (Health Level Seven) is a voluntary consensus standard for electronic data exchange in healthcare environments. It defines standard message formats for sending or receiving data on patient admissions, registration, discharge, or transfer; queries; orders; results; clinical observations; and billing................
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