“In an open architecture, components have well-defined, published interfaces that allow interconnection and use in ways other than as originally implemented or intended. They allow interested parties to expand the functionality of the system without modifying existing components.”[1]
This plea could apply to the use of an off the shelf database system customized for patient records and bio-medical information. A relational database can extract correlations between the two, offering a differential diagnosis. Each specialty or student can modify the posting forms and the reporting forms to meet their own need.
Arguably, today’s practice places far too much emphasis on treatment, best evidence, and far too little on diagnosis. Many if not most diagnoses prove wrong. Correcting the record or even learning of the insufficiency remains difficult. Reasons for these discrepancies include: insurance clerk posting the most reimbursable diagnosis, making a snap diagnosis without exploring underlying or concurrent problems, failure to consider all the possibilities, lack of environmental and epidemiological information, expense and inaccessibility of current biomedical information.
A prodigious number of records accumulate over the life of a practice, more than in most clinical studies. Data mining will reveal statistically significant correlations peculiar to local population and trends. The diagnosis will evolve over time. With time, the physician can apply statistical probability to the differential diagnosis. Intriguingly, it becomes possible to correlate the patient’s genome with clinical condition and outcome. Every patient becomes a well-documented study of every event from treatment to genomics.
The practitioner may link-up with a medical school or research center for support, billing and education. Linkage provides a continuing real-time updating of medical information, diagnostic criteria and best evidence. The institution receives a significant contribution to an anonymous database that correlates genomics with clinical experience and provides a horizontal cohort study of everything else on every patient. Informed consent is no longer an issue.
In progress
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