The Hamilton Spectator
Tuesday, July 8, 1997
page A9

Better care with computerized medical records

by David Parnas, parnas@qusunt.crl.mcmaster.ca

My parents were old-fashioned doctors. They made house calls, had evening office hours, and kept the office phone by their bed. If one of their patients became ill, my parents were there to decide just how serious the illness was and whether hospitalization or a specialist was needed.

Today's doctors aren't that foolish. Unlike my father, they recognize their own humanity and limitations. However, old-fashioned medicine had advantages. Patients were attended by someone who knew their history, knew what medicines they were taking, knew their personality quirks, and had access to their records.

Patient Information

If you or your child become sick when your own doctor is not on duty, the substitute doctor must rely on what you say and may do unnecessary tests and inoculations or treat you incorrectly because of lack of information.

If you switch doctors, for any reason, there may be a delay before the records get to your new doctor. Further, the new doctor may have difficulty interpreting your old doctor's notes.

The unavailability of old-fashioned basic care often sends patients to an emergency room, thereby adding burden to our increasingly strained emergency hospital facilities.

Two changes would improve the situation:

Some doctors will object to being forced to use a specified computer system. However, making sure that patients' records are always available for emergencies is a reasonable demand.

Further, a well-designed software system would save doctors time while improving record quality. If the system provides menu items and/or codes for common diagnoses, comments, symptoms, and treatments, a doctor could quickly prepare a complete record in the standard format. The standardized format would allow efficient and effective searches and queries.

Loss of privacy

Some will fear loss of privacy. Such concerns are exaggerated. When I go to a doctor, I give up privacy. I talk about things I don't normally talk about and expose parts of my body I don't normally expose. I choose a doctor whom I trust with intimate knowledge.

Making my medical record available to a physician who is treating me is not a violation of my privacy; it is making sure that I get the best possible treatment. Well-designed software would restrict access to information and keep a complete record of who received it. Your information would be available to the caregivers treating you, only while they treat you.

Pharmacists would only get the information that they need to check for drug incompatibility and to give you the appropriate warnings. OHIP employees would get only the information that they need to do their job. Such a system would make it easier to detect billing errors, fraud, and addicts who visit many doctors to get extra prescriptions.

The introduction of a standardized computerized medical record system would improve the quality of our medical care. It would also reduce the load on our hospitals and laboratories. As in many other situations, we will find that by improving the quality of service, we can save money. In contrast, when we focus on saving money, we often succeed only in postponing or redistributing costs.


David Lorge Parnas is NSERC/Bell Industrial Research Chair in Software Engineering at McMaster University. He is a member of The Spectator's Community Editorial Board.

Copyright © 1997 by The Hamilton Spectator. All Rights Reserved. Reprinted with permission.