Trevor Kerr of Southern Health Pathology in Victoria, Australia presents some random views on EHR’s, Government and medicine. Electronification of health records is opening up gaps as wide as those that separated peoples’ ideas during previous social revolutions, eg abolition of slavery, steam power, telephonics.

The electronic health record (EHR) is a confused mix of concepts, but one thing is certain, it is being driven by commerical necessity. Of course, one pillar of EHR is rooted in the public domain. But, governments that are happy to promote addiction (nicotine) as a means to extract more taxes, cannot be trusted to pursue a goal that is driven by public interest. Public bodies, self-help groups, consumer advocates and that blancmange called the ‘open source community’ need to find ways of forcing the economic formulae out into the open, for vigourous and continuing debate.

This article in the British Medical Journal is one of three on privatisation of primary care in the April 21 issue. All three are essential reading, but Table 2 is the most informative, especially comparison of ‘turnover’. If managed care (corporatisation) is based on competition between providers, then surely that is the reason for high turnover of clients (“patients”) between schemes. And if the assignment of risk is based on actuarial computations, then what data is required to “trade”, say, a hundred diabetics for fifty arthritics? Obviously, as much historical data as possible.

This e-journal article (subscription required) – Managing the care of health and the cure of disease–Part I: Differentiation. Health Care Manage Rev. 2001 Winter;26(1):56-69; discussion 87-9. Review. by Glouberman S, Mintzberg H. –
gives an appealing overview of the dynamics of health care management. Their model is that of four spheres of influence: cure, care, control and community. These forces compete with each other in some contexts, and collaborate in others. The coordination of clinical (ie bedside) *care* is the domain of nursing. The article is well worth reading and I will contact the authors to see if it can be made available.

In conclusion, any technology that is designed to be applied in hospital wards must be evaluated from the outset with the collaboration and direction of nursing management.