Summary. A patient
This NHS concept was the
business plan put together in 1997-1999 and taken to venture capital markets
just before Nasdaq crashed in April 2000. The proposal was prepared with
others including partners in the USA (www.technorama.net) and NHS partners.
Copyright Dr Bulger 1997-2008 Anyone
wishing to take on or
revive these idea please contact me
Since we wrote this the NHS set about developing its
multi-billion Electronic Medical Record and National "Data Spine" (NPfIT NHS Connecting for health)
In that model the
State owns the medical record which in part will be held centrally (the
spine), but most of the data will be held within regions LSPs (local
service providers), although by 2008 a more pragmatic approach is evolving
By May 2005 many others were were on similar lines that we
outlined below such as www.medem.com and now Google Health is constructing another model.
The 1997-9 Cunning plan:
Free to patients:
Our UK plan was called Medibank as people would "bank" their medical
details, as they now do with their money. This service was to offer a
secure international and pan-European method of holding medical records
through the internet. A patient anywhere in the world, or
his authorized hospital or physician, would have access to, and be able
to work on the same data. It would be free to patients and nominal for
organisations to access.
Medibank works easily with Medical
Data Protection Acts, by making it
clear that this medical record belongs to the patient, and it is he or
she who authorizes who can have access to the record and at which
level. However, like with any monetary system the patient would
have to accept the "currency" of a medical record which will have an
audit trail. One can own a £ coin but not deface it.
There would have been tiers of access, subject to patient
acceptance. The lowest level of access allow reading of aggregated and
anonymised data for reading by patient specified charities, health
departments, and drug companies with patient permission. The highest
level would be the full read and writing powers of the entire record by
the patient's primary physician (it is not clear in the NHS
Connecting for Health model who will have such "root" permission),
The patient would have a masking ability and high level of authority on
the record, and be able to look and add comments to the record. The
patients would be to add details including their recent blood pressure
monitoring or blood sugars or whatever.
departments within a hospital, between hospitals and
the family physician would be able to work from the same “live” record.
When first attending a hospital the patient would give his pin number
allowing the hospital to look at the record and to post their latest
findings. The G.P. would identify the patient in front of him or her,
when merging local clinical data with the patient's Medibank record.
The patient would have a pin number.
service would have its own "clinical software"
interface, which would include drug and disease registers. The
service will be open to any other clinical and hospital software
providers to post their data to the database engine, allowing their
users to continue to use their interfaces and systems and local
record. The source code and methodology to do this would be open
source. (The NPfIT scraps current
would have been using the international standards
that have been developed over recent years, including the development
of HL7 standards and SNOMED, and Read coding systems. There
were similar ideas being developed in the USA, principally flowing from
Healtheon.com and its associated companies. There are difficulties for
these products to move to a European Health model. The U.K. Health
Service was developing an electronic medical record that is a
would have started by offering services charities that
support patients with chronic diseases. Once the Medibank software
engine has been established, numerous marketing options and other
products open up. One would be a "referral engine" (now called
Choose and Book by the NHS) which transfers and audits the referral
process between specialists, hospitals, and general practitioners.
There are many different products that can be spun off from the central
Income generation is
derived from offering the security of the service. Patient
access would be free. Other users, hospitals, doctors, etc would be
charged say £1.00 to put the security tag onto a patient's
record, which would allow access to that record. After non-use of the
record over a two-year period the tag would time out. As patients
moved hospitals and changed G.P.s the churn would produce the income.
Patients would have a log of who accessed their record. Patients would
give permission, and may even allow charities and drug companies to
access it if they so wished. This would have been the patient's record,
not the Government's.
Hospital, G.P records and the patients own record would
only merge into one patient record when the patient so agreed at the
G.P.s surgery, by way of a pin number, and once the patient was
Archway Surgery PMS. 52 High Street, Bovingdon, Herts
833380. Fax 01442
http://www.medibank.nhs.uk is just this link
© Dr Gerard Bulger March 2000 and Mary 2008