I’m used to typing my medical records notes myself. Probably because I’m a pretty good touch typist, but there are other reasons, too. For one, I’m not used to dictating into a machine. It simply feels unnatural to me. It’s like having a stenographer on your lap, but without the advantages.
Another reason is that I like to go back and forth and fill in the blanks as I interview the patient or do my clinical examination. So I prepare the record while the patient is present and I can’t imagine dictating while the patient listens in on what I say, so I’d be very constrained in what I could dictate. Like: “The pain story the patient presents seems unusual. Could this be an insurance neurosis?”, then turn to the patient and ask “exactly how often does that leg of yours hurt?”. Seems kinda weird to me. Dictation would force me to let the patient go before I organize my thoughts and dictate, and any extra information I discover a need for will remain lacking, since I can’t ask the patient for it. He just left, remember?
Continue reading “Dictation? Get over it already!”
I was reading an article in New Scientist, the May 13 2006 issue, p 32-38, “The Incredibles”, about the enhancement of humans by biological and technical means. It’s all about how we are able to not only combat disease and reduce premature death, but how we are increasingly able to improve healthy human beings to a superhuman state and prolong life beyond the “normal” borders. Among the abilities we can and want to add are increases in learning abilities and hookups to electronic memories.
The very nature of learning has to change to enable us to take full advantage of these techniques, however. So far, the largest part of learning a profession has been memorizing facts. For instance, learning medicine has largely consisted of learning a number of diseases and their symptoms, evolution and treatment. Continued professional education involves unlearning some of the stuff that has in the meanwhile been discovered to be false and learning some of the new stuff. An “experienced” doctor is in general the one that has seen the most medical problems first-hand and has an easier time of remembering and recognizing them the second time he sees them.
Continue reading “Google in your head”
Increasingly, computers are used to write pharmaceutical prescriptions and other medical documents. In most cases, the “signing” of these documents is a sad affair involving some simple checking of checkboxes and clicking of buttons. The application usually takes it from there, attesting to anyone willing to believe it that the logged on user (whoever that may be in reality) clicked the click and thereby took responsibility for the whole thing.
In more sophisticated systems, an actual digital signature is applied to the prescription. If we’re lucky, it’s also done in the right way (except I’ve never heard of a system doing it right), with digital signatures. If we’re even more lucky, that digital signature is not kept on the computer, a floppy, a USB flash memory or a dumb card (a magnetic stripe card or memory card), but on a smart card with microprocessor. But even then, we’re far from safe.
Continue reading “Smart cards should have keypads and beepers”
When we apply a digital signature to a data structure, we only apply it to the data actually present in the structure. But most of that data is only meaningful in relation to external data tables, and used with certain applications, which can change without influencing the signature on the data structure. This is a serious problem in many application areas, but in none as much as in medical informatics.
Continue reading “The Semantics of Signing”
A discussion of how future medical information communication systems could be built for maximum security and openness. Multiple actors do want and need access to the architecture so they can freely select components to fit into the architecture. These components can be conversion engines and scripts, maintenance systems, encryption and signature systems, and communication links.
Those medical institutions, labs and care providers that have moved over to computerized medical records usually are able to send requests, reports and other communications to each other using computer networks. Often, this is done by third party systems that centralize the conversion of the data. These third parties usually also provide the communication infrastructure and the necessary client applications, but it’s a cultural thing, so it varies a bit from country to country. For a number of reasons, I do think the time has passed for these third parties, even though they’ll probably be in business for a while longer. Nothing in medical computing changes very quickly.
Continue reading “Medical data communication systems, next generation”