ideaman911 wrote on Tuesday, October 06, 2009:
Folks;
I presume that any system can be overcome by a knowledgeable person. Even twin towers, remember? That said, I also believe OpenEMR currently timestamps and user stamps every input once saved. How is that different from what you are describing above? As to when it "autosigns", that effectively happens as soon as a SAVE occurs. More critical may be the fact that you can write the History of Western Civilization, but if you forget to save, it is lost without a prompt!
As to who holds and their relative trust, you obviously don’t have a credit card balance. I think that most ultimate users will want to hold their own data rather than trusting it to someone who can go belly up without bothering to tell them. It happens. And OpenEMR was developed with stand-alone capability, so it is a selling feature, at least until Orwell the Optimist and HIPAA are overridden for "connectivity" and EHR.
My point is that we must as much as possible guard against presuming any way WE do something is the universe of possible ways of doing it with our software. As CCHIT has already demonstrated, it is incapable of dealing with the reality of home care in rural (non-fast internet capable) areas. Lets not design for exclusion.
I daresay most small providers will be far more trusting of their own users’ data than any central holder. That they will select a central holder anyway will say more about their internal confidence in their IT capabilities than the security of their data. And I agree with Dr. Bowen.
That all said, I believe an "electronic signature" is important, especially for Notes, SOAP, and any other open-ended text inputs. I do wonder where the threshold exists, though. Most of the database fields are capable of 255 chars. That’s a lot of text. Will each field have to be signed? Where does important end and ridiculous begin?
Joe Holzer Idea Man
http://www.holzerent.com