Katrina & Outliners

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Note: This message is from the outliners.com archive kindly provided by Dave Winer.

Outliners.com Message ID: 4210

Posted by cob111
2005-09-26 08:38:50

One aspect of the Katrina National Disgrace is the absence of medical records for those who evacuated from New Orleans with the notable exception of veterans served at the New Orleans VA. It is possible to access (with proper authority) the medical records of the New Orleans VA patients because the Friday backup before Katrina hit was saved and mounted at the Houston VA for all practitioners in the VA system to access when they saw evacuees anywhere in the VA system. It is possible to look at the “outline” of the NO VA patient’s medical record by using a utility called VistaWeb that brings together all the electronic medical records recorded at any VA Hospital or outpatient clinic. One can then click on “Problems” and see an “outline” of the patient’s problems that is essentially an annotated list of problems. This outline enables one to identify dates when problems were recorded. Then one can go to those dates in the “Progress Notes” and understand details of the problem.

The Center for Medicare and Medicaid Services has released a beta version of the VA EMR software called Vista-Office (http://www.vista-office.org). It like the VA EMR, VisTA, uses outlines and facilitates the documentation of what has been done for prevention purposes using “form filled hypertext” whereby one clicks on questionnaire answers (in outline form) and text is automatically generated in the note. Vista-Office like the VA’s VisTA EMR is written in Delphi. The Vista-Office database is Intersystems’ Cache - a hierarchical database (http://www.intersystems.com).

Within VisTA and Vista-Office are lists and “outlines” such as the Problem List, Medication List, Allergy List.

There should be a national effort to enhance Vista-Web so that practitioners can easily enter “outlines” in a format, OML and/or OPML such that the “outlines” of a visit can be transmitted centrally for all patients (uninsured, Medicare, Medicaid) who are seen for care. Then patients can then be assured that their medical records will be available when and where they need them. Folks other than VA patients will have this basic health care right. This will benefit everyone.

Are there folks in the outliner community who are interested in customizing Vista-Office (http://www.vista-office.org) so that OML / OPML based outlines are integral to that electronic medical record?

Charles Beauchamp MD, PhD
Clinical Assistant Professor of Medicine
Durham VA Medical Center
Duke U. School of Medicine
cobATTDuke.edu
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