Discussions of Interoperability Exchange, Privacy, and Security in Healthcare by John Moehrke - CyberPrivacy. Topics: Health Information Exchange, Document Exchange XDS/XCA/MHD, mHealth, Meaningful Use, Direct, Patient Identity, Provider Directories, FHIR, Consent, Access Control, Audit Control, Accounting of Disclosures, Identity, Authorization, Authentication, Encryption, Digital Signatures, Transport/Media Security, De-Identification, Pseudonymization, Anonymization, and Blockchain.
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Tuesday, July 10, 2012
Are Documents Dead?
As I am looking over potential comments to the mHealth profile, I find Gary's post asking, in the context of the mHealth profile, if Documents are Dead. I don't know why this is relevant to the mHealth profile, except that it is document based, so far. Meaning that the goal of the profile is actually to give access to documents. Thus it does start with the premise that documents do exist and people/systems want access to them. Reminder the profile is actually "Mobile Access to health Documents (MHD)", it is just referred to as mHealth simply for the marketing.
I find it very interesting that Gary uses a Document to indicate that Documents are dead. The blog post is a Document. The format clearly is different than historic documents, but the concept that Gary has taken past experience and research; applied his brain; and produced a new concept that is Documented into a format that tells a story... a document...
The Document is far more the conclusion of a past set of thinking. The blog article is now being split up into datum by the likes of google and bing; it is being recollected in the likes of RSS feeds; and likely republished in some newsletter like deployment. I see these very things happening with healthcare documents. The document is not intended to be an input to a human, it could be; but rather the human is an inference-engine intended to treat a patient given historic knowledge and then document the reasoning and what was done. I certainly hope that humans can get a more relevant format as input than a blunt list of historic documents. But ultimately something must have decomposed the historic information.
There is a circle of information, a document is just one step. And a blog only proves that the "document" has a place on this life-cycle.
Thanks for your post John. I agree. The "level" of a document is important, because you can only decompose up to a point before meaning is lost. Tell a novelist that their work can be dissected into its chapters, sentences, words, letters, or bits! Tell a doctor that the progress note they documented does not have to be taken in its entirety. True a paper book is not the only delivery mechanism -- book can be read on the web or Kindle/nook etc. But still, the material is all together and you get what the writer intended. In the case of patient records, there is definitely merit in thinking beyond the boundaries of single documents or a single provider's "chart" (which is itself a collection of many documents, not just atomic-level facts) --- I totally agree with thinking beyond these boundaries. But at some level, some set of facts/words/interpretations are put together and documented, and I think that concept needs to be preserved.
ReplyDeleteDavid