Medical record search engines, using pseudonymised patient identity: an alternative to centralised medical records

Purpose The purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. Methods We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. Results We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. Conclusions Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities.

La medina andalusina de Lleida en el segle XI: identitat i societat

La ciutat a Alandalús és l’espai hegemònic del poder públic emiral i posteriorment califal. Partint de la ciutat de Lleida, analitzem la evolució des del segle VIII fins al segle XI de la consolidació dels espais urbans com a representants del poder. Talment, aquests, capitalitzen els districtes o cores, mitjançant una xarxa de ciutats i fortificacions que li donen cohesió interna. Paral∙lelament, es vertebra i s’envigoritza una societat urbana partint d’elements comuns d’identitat i d’un discurs ideològic afí a la dinastia Omeia. La “gent de la ciutat” repre‐senten una part de la societat andalu‐sina, d’arrels hispano‐visigodes, i alhora, assumeixen l’hegemonia cultural de l’Islam, tot convivint en la nova realitat político‐social.