Regan B G
Department of Information Technology and Quantitative Methods, University of Newcastle, NSW.
Med J Aust. 1991 Jan 21;154(2):140-4.
The slowly increasing use of computers in the management of general medical practices may be greatly accelerated if new technologies for the storage and transfer of information are introduced. Electronic data interchange promises to speed the transfer of medical data, insurance information and payments. Smart cards promise a portable, up-to-date, confidential medical record that can be carried by patients. However attractive these new systems may be to computer suppliers and government bureaucracies, it is not certain that they will be as attractive for the general practitioners who will be required to implement the changes. Smart cards may exacerbate problems with the ownership and privacy of data, rather than guaranteeing confidentiality and control. Data exchange through a computer network may allow many information services not actually essential to general practice, while creating serious new possibilities for breaches of privacy. Costs in implementing the new technologies for general practices may outweigh any gains in efficiency, which could in any case be achieved through better use of paper records. The Health Insurance Commission may see advantages in the collection of data on the diagnoses of patients that can be used in epidemiological studies and in the control of overservicing, but there will be practical limitations on the reliability of the data collected by this means. General practitioners should carefully consider their attitude to these new technologies before suppliers, governments and others make their record-keeping decisions for them.
如果引入信息存储和传输的新技术，计算机在普通医疗实践管理中的缓慢应用可能会大大加速。电子数据交换有望加快医疗数据、保险信息及支付的传输。智能卡有望提供一种可由患者携带的便携、最新且保密的病历。然而，这些新系统对计算机供应商和政府官僚机构可能颇具吸引力，但对于需要实施这些变革的全科医生来说，它们是否同样具有吸引力尚不确定。智能卡可能会加剧数据所有权和隐私方面的问题，而不是保证保密性和控制权。通过计算机网络进行数据交换可能会带来许多对普通医疗实践并非真正必要的信息服务，同时也为侵犯隐私创造了严重的新可能性。在普通医疗实践中实施新技术的成本可能超过效率方面的任何收益，而效率的提高无论如何都可以通过更好地利用纸质记录来实现。健康保险委员会可能会看到收集患者诊断数据的好处，这些数据可用于流行病学研究和过度服务控制，但通过这种方式收集的数据的可靠性存在实际限制。在供应商、政府和其他各方为他们做出记录保存决策之前，全科医生应仔细考虑他们对这些新技术的态度。
