Country Notes

For certification links and information, see the wiki page Certification Requirements

Canada

Switzerland

USA

Other info

Canada

  • National Drug listings are available from:
    • Health Canada (use of the data requires a release but it can be downloaded with the
      • readme that describes the data structure
      • the files themselves are here

British Columbia

  • Drug finder, cross-indexed against public funding here
  • Pathology
    • Hospitals and other public labs (Centre for Disease Control etc)
      • can direct specific doctors' results through a service MediNet via HL7
      • however each patient's report is transmitted as a text blob, there is no coding
    • Community (Private) labs
      • volume is large; 2 companies control 85-90% of the urban volume
      • these 2 largest companies (MDS Metro Labs, BC Biomedical) have formed PathNet
      • PathNet uses HL7 and LOINC via VPN but had been using the IPSec standard for encryption and authentication and having had problems is believed to be switching to SSL VPN (enabled ~ September 2004), one EMR vendor (Med Access?) tried to get a Linux server to pick up the labs
      • an alternative data service provider (MediNet) provides a mailbox service from which doctors and clinics can download results, reports and documents. End-users can simply print or import into an EMR provided it has set up appropriate interfaces. However only a small portion of the data is HL7 formatted, and the codes are ASM not LOINC. The other files are plain text, into which MediNet has inserted text headers to help EMR users link patients information (text blobs) to distinct patients.
  • Radiology
    • Hospitals have been auto-faxing reports; "working" on EMR support but progress invisible
    • Community (Private) centres issue paper reports; state of any IT plans unclear

Switzerland

Personal Notes (translated and modified by -- DominiqueBuenzli? - 29 Jul 2004 ) on the computerized medical file from M. Ruud W H de Ruiter, member of the "Computerized Medical File" mailing-list of the Swiss General Practitioner organization.

  • It is not possible to exchange effectively data between softwares actually on the market because the developers/designers, at my knowledge, didn't agree on a exchange protocol. They could take as an example the protocol used in Belgium for the computerized medical file.
    • In general, the developers/designers provide an export in CSV format, but in many of them, without the ability to import this format !!
    • I've got the impression that we didn't ask ourselves if there is such a protocol and used elsewhere. If yes why didn't the developers/designers use it ?
    • Even if the Belgium protocol (already in use since a few years) or the French one (medical record obligatory in 2007) is not adapted to Switzerland, it is better than nothing.
    • European union: maybe there is a european protocol ?? To investigate/do

  • Tarmed filter (the new swiss billing system. GERMAN: http://www.fmh.ch/tarif-browser/de/ ), OAMal (law of the application of the health insurance) etc... according to the intrinsic value and the speciality of the doctor
    • Tarmed has got 5000+ billing items. For a GP only about 300 will be useful.
    • Software designers have until now, integrated the complete CD (with the 5000+ billing items) but, to my knowledge, no one has done a correct job by providing such a filter
    • Some of these softwares have the ability to create a personalized billing (i.e.. only the 300 necessary) but why this manual work. Weren't the computers invented to do that kind of work.

  • All the systems working on the base of a permanent WWW (Internet) connexion with an external server have weaknesses by defaults.
    • If there is a network access problem or overwhelming traffic on the ADSL, cable connexion or if the server crashes, no more access to the data is possible anymore and the GP practice is not functional anymore
    • If the provider of the external server banquerupts, there is no assurance that the data will be retrievable
    • An "off-line" utilization is not possible.

  • A system working under the replication system (or similar) gives much more security:
    • a mono-post solution is possible
    • a "off-line" utilization is possible (e.g. on a laptop )
    • If there is a network access problem, the GP practice is still able to work
    • Choice between an local or external server (any PC can be a server)
    • It does not matter if the server is external or local, the database is (or can be) at any moment on several computers. This is a good guarantee to prevent data loss.
    • Only new or changed data has to be exchanged. Normally once a day is enough. Only if a patient is hospitalized in emergency, then an additional replication is needed. In this case it would be good to be able to replicate his file by mobile phone.
    • Perfect access control, i.e. access available to other doctors from the region when they are on call, so they can easily access patient files of unknown patients.
    • Risque of hacking. Never 200% guarantee that it is not possible but this is also true with paper files. With a system that obliges the doctor to change his password every 30 days and crypted connexions, an acceptable protection is provided
    • To be complete, the doctor should also have a firewall, antivirus (updated regularly !!) (alternative: buy a mac wink ) as an anti-spam software.

  • As a general rule, when a company offers a medical software, they want to include "all". This has the bad side to have a too heavy/unfriendly software to use.
    • The software should be customizable according to the doctor needs only.

  • Need for multiplatform: pc, mac....

USA

Other info:

Structuration of the computerized medical file (from the homologating of computerized medical file for the GP of the Belgium Government Health Site)

http://www.health.fgov.be/telematics/label/mh/struct/structuration_epr_2003.pdf - ENG

European Standardization of Health Informatics

http://www.centc251.org/ specially this section http://www.centc251.org/WItems/listwis.htm (e.g. WI 098, WI 102, WI 109, WI 110, WI 111 )
Topic revision: 08 Nov 2009, JamesBusser
 
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