Letters Setting the (medical) record straight MJA 2000; 173: 670
| |||
|
To the Editor: The electronic health record is a concept which has been
receiving growing community support. The recommendations of the
National Electronic Health Records Taskforce were endorsed at the
Australian Health Ministers Conference in July 2000. The Taskforce
proposes establishing a national health information network
(Health Connect). Healthcare providers would enter event summaries
into patient records. The data could then be exchanged online. The
report recommends that patients (or "health consumers") have access
to their own records and control who can view them. This technology has
the potential to improve patient care, but requires careful
planning. A recent patient encounter highlighted a problem with our
present medical records.
A 31-year-old woman was admitted to a nearby hospital with fever, a productive cough, and pleuritic chest pain. A chest x-ray confirmed right lower-lobe consolidation. Blood cultures revealed Streptococcus pneumoniae with intermediate penicillin sensitivity. Her condition responded well to intravenous penicillin and a week of intravenous ceftriaxone with the "hospital in the home" (HIH) program. The discharge diagnosis was pneumococcal lobar pneumonia complicated by bacteraemia. Two days after discharge, she presented with the same symptoms, this time to our hospital, giving a history of her previous illness and admission. She was again febrile, but, interestingly, her chest x-ray was now clear. Her sputum cultured Streptococcus pneumoniae with an intermediate sensitivity to penicillin. An extensive septic work-up was otherwise unremarkable. Given the relapsing course, she was again treated with intravenous ceftriaxone with the HIH program. We found this recurrent febrile illness puzzling. The answer became apparent when she wasn't recognised by the HIH staff who had treated her previously. A sister visiting from overseas had become ill and used our patient's Medicare card to receive free treatment at the neighbouring hospital. The sister made a complete recovery. The real card owner then developed similar symptoms. To avoid detection she chose our hospital and used her sister's recent history as her own, not realising that the two hospitals shared the same HIH program. Thus, there had been two different patients with separate illnesses using the same Medicare card! For the second user of the card, this precipitated a prolonged inpatient stay with unnecessary investigations and treatment. This case highlights one vulnerability of our data recording system. There are few safeguards to verify patient identity on admission and, once recorded, data are filed permanently. Are more rigorous checks, such as a photo ID on Medicare cards, warranted? Is the loss of patient privacy outweighed by savings to the taxpayer, given that ultimately the cost of such exploitation of our system is borne by us all? Alan C Young
Peter W Holmes
©MJA 2000
Readers may print a single copy for personal use. No further reproduction or distribution of the articles should proceed without the permission of the publisher. For permission, contact the Australasian Medical Publishing Company. Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia <http://www.mja.com.au>". <URL: http://www.mja.com.au/> © 2000 Medical Journal of Australia. We appreciate your comments. | |||
Previous