Chipping

[Nearholmer]

One option, once a viable system can be devised, might be to start gently, enrolling each new baby at birth. If left to its own devices “100% cutover” might take about 110* years, with 600k new-form records being created each year, and 600k sets of all the old gubbins being deleted, which might make it the fastest IT system deployment in the history of the NHS. Just joking!

*Maybe 120, allowing for a bit of super-aging and some retention of old records post-decease.

[Psamathe]

Unsure how serious the chip proposal is (given that chips do fail ...) but there would be a cost so Government would never do it just for NHS health records (or access to NHS health records through tag ID) but it would become a universal (UK wide) ID for everything (passport, drivers licence, health, Social Security, etc.) and look how well the last attempt at that went - not that long ago and that didn't even involve tags/chips.

And given that tags can be read from a distance the possibilities for location tracking using such technology becomes potentially viable ... so it wont happen.

I think the population would need to have a lot lot lot more trust in Government before even universal ID would be possible and currently seems to be going the other way with increasing loss of trust in Government.

Ian

[Nearholmer]

I didn’t read the “chipping” bit as serious, but the ready access to records thing definitely is. It feels as if it ought to be an opportunity for both greater efficiency and greater effectiveness, but ……. privacy issues, scope creep into identity, hackability, stealability/security (a standard thing for the Russians to do when invading a country is to grab all the health records, because that gets all the health professionals, and all the patients by the short and curlies), the tendency of giant IT systems to become dysfunctional behemoths, if they work at all, etc etc ……. It’s no wonder it hasn’t happened yet!

[simonineaston]

Let's face it - there's a very large box indeed, clearly labelled "Great Ideas that'll never get done due, not so much to the cost or the difficulty or absent technology, but rather - our inability to agree..."!
see too, Keeping The Planet Liveable Onable

[Nearholmer]

Yes. I think it lives alongside the other box labelled “really bad ideas that will cause endless trouble and deep grief”, but some Greek woman opened that one years back, I think.

[Psamathe]

Re Medical Records: Maybe it's a question of degree. Maybe we can achieve significant improvements with small changes. Maybe a perfect solution would cost too much, take too long and its scope would raise important reservations.

Eg a couple of years ago I saw a neurologist (consultant) at Norwich main NHS hospital. He raised something to which I answered "I had a brain MRI scan 2 months ago" and he was overjoyed, got on to his computer and ... I told him it was done at James Paget (Great Yarmouth) NHS hospital 25 miles away and he couldn't get to see it. Just addressing stupidity like that could gain a lot of improvement but without the massive costs, delays, privacy, etc that some impractical IT specialist might dream up.

Ian

[Carlton green]

I didn’t read the “chipping” bit as serious, but the ready access to records thing definitely is. It feels as if it ought to be an opportunity for both greater efficiency and greater effectiveness, but ……. privacy issues, scope creep into identity, hackability, stealability/security (a standard thing for the Russians to do when invading a country is to grab all the health records, because that gets all the health professionals, and all the patients by the short and curlies), the tendency of giant IT systems to become dysfunctional behemoths, if they work at all, etc etc ……. It’s no wonder it hasn’t happened yet!

Such abuse is just one of very many that await us. What’s for sure is that well intention folk will have the fruits of their labour mis-used and taken from them; unfortunately the world has many thieves and bullies in it, it always has had and doubtless always will. That’s sad but true, and being now retired I have the free time to see a little of the shocking truth.

[pjclinch]

Re Medical Records: Maybe it's a question of degree. Maybe we can achieve significant improvements with small changes. Maybe a perfect solution would cost too much, take too long and its scope would raise important reservations.

Eg a couple of years ago I saw a neurologist (consultant) at Norwich main NHS hospital. He raised something to which I answered "I had a brain MRI scan 2 months ago" and he was overjoyed, got on to his computer and ... I told him it was done at James Paget (Great Yarmouth) NHS hospital 25 miles away and he couldn't get to see it. Just addressing stupidity like that could gain a lot of improvement but without the massive costs, delays, privacy, etc that some impractical IT specialist might dream up.

At least up in Scotland that would be in National PACS (the great majority of scans/images go to a national archive) so that would make accessing it a whole lot easier from a different board than it was taken in. We do seem to have a better integrated whole up here (made easier, of course, by having rather lower population in the entire country than just London on its own, but also it's in the charge of a government who may not be enormously competent but at least aren't trying to set up NHS Scotland to flog choice bits of it to their mates).

As an indication of how hard fully digital patient records might be, back around 2018 IIRC a contract was awarded in Scotland to re-do the Community Health Index, which is a unique ID number for every patient in Scotland. The original formulation was well before the millennium so has 2-digit year of birth codes that are now a liability, and ultimately we'll just start running short of numbers in the current format. So the job is providing everyone in Scotland with a unique ID number that gives their DOB and really that's about it. Pretty minor compared to a full patient record!
The MSc module I teach on Clinical Imaging Data had a slide on how the CHI was worked out, but I took it out a couple of years ago and replaced it with a "there's a new CHI coming along soon, watch this space" slide. I put the original back in this last session, because there's no sign of the new system being delivered...

Pete.

[Cugel]

I didn’t read the “chipping” bit as serious, but the ready access to records thing definitely is. It feels as if it ought to be an opportunity for both greater efficiency and greater effectiveness, but ……. privacy issues, scope creep into identity, hackability, stealability/security (a standard thing for the Russians to do when invading a country is to grab all the health records, because that gets all the health professionals, and all the patients by the short and curlies), the tendency of giant IT systems to become dysfunctional behemoths, if they work at all, etc etc ……. It’s no wonder it hasn’t happened yet!

Such abuse is just one of very many that await us. What’s for sure is that well intention folk will have the fruits of their labour mis-used and taken from them; unfortunately the world has many thieves and bullies in it, it always has had and doubtless always will. That’s sad but true, and being now retired I have the free time to see a little of the shocking truth.

Just so .... and some further shocking truths are now turning to a shocking reality. The shocking truth is that human history as far back as we have evidence for indicates that most societies are dominated by nasty-humans all to keen to control every aspect of their subjects' lives and doings. Potential control mechs are now much more sophisticated and powerful. Just ask Cambridge Analytica or Pukin.

Despite "the better angels of our nature" (ha ha) it's fairly clear that current history has developed a vector back to this norm after (for us Blighters at least) the kindly but anomalous period of post-WWII. Europe is marching rightward, to join the many other totalitarian regime-types already dominating and subjugating their subjects (and their neighbours) around the planet.

When we too are subjects rather than citizens, with a Farago or similar doing the dictating, there'll be no choice about having the sort of chip discussed. It's primary purpose will be uber-control. The progress of technology and its driving memeplexes makes the possible degree of control immense.

All subjects will have a large range of parameters to test for. One will be related to the control of immigrants. No chip or the wrong chip and it's built-in biological process wrecking sub-routines will be invoked. There'll be many other tests that result in such invocations. Virtual extermination camps - what a phantastical Reform that will be! The Musks and Thiels will be able to own everything rather than just the large chunk of everything they own now.

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On the other hand, its very possible that we'll all be dead of weather before the full Panopticon emerges. But its already half-built.

Doom! The end is nigh!!

[Cowsham]

My cat owns me so probably I'm the one needs micro chipped -- might help the next time I'm scraped up off the road by an ambulance.

[Cugel]

My cat owns me so probably I'm the one needs micro chipped -- might help the next time I'm scraped up off the road by an ambulance.

Ha - you know the cat won't care and will just acquire another slave. On the other hand, it might claim your corpse as feed-stock for some rather up-market catfud.

[briansnail]

Waiting lists will vanish overnight.

No harm in trying.They need more medical school places (they have the people lining up).Now thats a vote winner for the Conservatives/Labour. Waiting lists meanwhile will only lengthen.Except for the rich.As UK gets older and older.
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I ride Brompton,Hetchins 531

[Jdsk]

When it comes to healthcare, even now it seems that data-sharing across the NHS is very weak, with GP and hospital only loosely linked, and a proneness to go round loops multiple times.

Everyone is terrified of falling foul of GDPR. The fines for doing so are enormous. It really stymies council healthcare systems (care in the community, council-run care homes etc) because it hugely restricts things like cross-referencing a person's medical records between the care home, the GP and the hospital.

I get that obviously there need to be stringent protocols in place for privacy, confidentiality and so on but the time it can take for even simple referrals is a by-product of that (plus other factors like chronic under-funding for a decade...)

Privacy and confidentiality are very important. And there have been some seriously misguided projects that didn't get this right.

But they aren't major barriers to making sure that that information isn't available where it's needed. However as you say the fear of them can get in the way.

And that relation between health care and social care is very important for many essential improvements. And is an instance of one of the two really big barriers.

Jonathan

[Jdsk]

Re Medical Records: Maybe it's a question of degree. Maybe we can achieve significant improvements with small changes. Maybe a perfect solution would cost too much, take too long and its scope would raise important reservations.
...

Yes, there are lots of examples where computerisation has brought great benefits. Roughly speaking they can be categorised into improvements in efficiency and improvements in safety.

Rather surprisingly making sure that the ones that have been shown to work are rapidly implemented everywhere isn't part of England's national strategy.

And scope is a major part of the other big barrier: who decides what gets done and what doesn't.

Jonathan

[Pendodave]

I'm not over familiar with this area, but presumably other countries with a similar population and a modern healthcare environment face similar issues.
Have any of them successfully implemented patient data sharing/availability, and if so, how did they make it work?