that information. With that said, when
it comes to ownership of the full medical record for that patient, there’s growing sentiment that this information
properly belongs to the patient.
The truth on the ground right now
is that any patient’s records are actually scattered among any number of
siloed databases since, as you go from
one clinic to another or from one pharmacy to another, each is going to create
a fresh record for you. When it comes
to determining who owns those records, I’m inclined to distinguish the
information that each practitioner is
responsible for maintaining on his or
her own system from the sum total of
all the medical information collected
about some particular patient over the
course of that patient’s lifetime. While
many believe this is information that
belongs to the patient, the current reality is that the patient doesn’t actually
even enjoy access to that data and has
little to no control over how it’s used.
TERRY COATTA: Just to be clear about
those silos, are you talking about centralized databases or just a lot of small
individual databases maintained in
different doctors’ offices?
EVANS: It’s essentially a mix of the
two. There are lots of independent doctors’ offices out there, and to the degree
they are using computer systems at all,
it may amount to little more than a database running on a desktop or laptop.
By the same token, there are healthcare teams that span multiple locations. One of the largest in Ontario has
37 different clinic locations that all
share a single EMR implementation
hosted in the cloud. But I believe even
that implementation is organized such
that doctors are able to see information for only those patients who visit
their particular clinic location.
MCDONALD: What does this look like
from the perspective of an admin working at one of these clinics?
EVANS: Even where EMR applica-
tions are in place, there’s a lot of aging
technology to contend with. Also, early
on, we were cautioned not to walk into
a doctor’s office just expecting to be al-
lowed to change the workflow. There’s
a reason these technologies haven’t
necessarily advanced all that much
since the 1980s. The doctors are used
to them. They reflexively know they
need to hit the tab three times on this
lished between patients and their vari-
That vision became the challenge
that HealthChain CTO David Evans
took on, drawing on 25 years of work
in the financial industry on portfolio management and quantitative research systems. In the years that led
up to his transition to healthcare, he
found himself increasingly intrigued
with the possibilities of applying
emerging digital identities and blockchain technologies to the creation of
more efficient government services.
Now he has an opportunity to put some
of those ideas to the test.
To provide some insight into how
HealthChain is addressing the medication profile–management challenge,
Evans is joined in discussion here by
Richard McDonald, a recently retired
IBM Distinguished Engineer, and Terry
Coatta, the CTO of Marine Learning
Systems, a Vancouver-based startup
working to develop a learning platform.
RICHARD MCDONALD: As people who have
had occasion to visit doctors’ offices—or even hospitals—from time to
time, we all know just how important
recordkeeping is to those operations.
Historically, that has taken the form
of paper records kept in overstuffed
filing cabinets. But increasingly, it
now seems also to include electronic
records as the medical profession is
making a belated push to fully enter
the 21st century. As that process continues to move forward, questions
come up as to who actually owns those
records, who looks after them, and
who needs to have access to them.
What do you see as some of the key issues with respect to the custodial responsibilities these various medical
organizations now need to address?
DAVID EVANS: As you say, at this point
there are doctors who use computer
systems and others who don’t. The ones
who keep computer-based records generally use some localized instrumentation called an EMR (Electronic Medical
Record) system (also known as an EHR
(Electronic Health Record) system,
depending on country and usage). In
terms of who owns the records kept
on these things, any doctor who enters
details about a patient into an EMR system is accountable for the accuracy of
Questions come up
as to who actually
looks after them,
and who needs to