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days as is determined, then there will be an investigation into that inquiry. Each office has an individual access code and password to either view or enter new information. No office will be able to change any old information. Old information can only be changed through the data base administrators and a physician's office. When a new patient is entered, the database will assign the three alphanumeric prefix. This way the patient can access their own data by knowing their prefix. The patients will not have the ability to change their data. The hospital and surgical center admissions office may also be able to obtain data only if they agree to update it immediately upon conclusion of their encounter. This may consist of the emergency room or hospital or surgical center admission date, diagnosis, and medications dispensed. I do not know how to deal with a patient that presents incapacitated and, therefore, will not be able to give the two digits of their mother's maiden name. This may be able to be obtained via a relative or by knowing the patient's prefix, which will be kept on file at the doctor's office, emergency personnel would be able to obtain this and, therefore, data that way. At the end of each doctor's office visit, the record should be updated with a summary not to exceed so many words, such as 50.
Individual doctors' offices could query the database on questions as relates to the entire database, but cannot query on patients they are not seeing. Insurance companies, health maintenance organizations, and large organizations such as hospitals can only query the database through the data base administrators. They can query whole data base information only, not obtain records of individuals. There should be a limit of the number of inquiries per month, and a fee for each inquiry. There should be no inquiries allowed for three to five years after the data base has been started if no back data has been entered. This brings up the question of do we need to input all previously seen patients. This would be a phenomenal task, especially at large family practice and primary care groups. Instead, I propose that only new patients be inputted and, therefore, over a three to five year period a substantial database will be developed. During the interim, it is those patients that are in the system that we are seeing that we need to know the information about and, therefore, that is the information that is important to the physician.
There are still questions that have not been answered. The database of the server may have to be fairly large, there must be a secured programming group, which develops how the data will be viewed. The number of inquiries per hour can become staggering. Additional specifics on the security of the information will also have to be addressed. The prefix prevents outside individuals from investigating the data, the initials and social security number have some benefit and the first two letters of the mother's maiden name allows some security from those offices that have the ability to input into the data base. Is the mother's maiden name secure enough to prevent a physician's office from inputting data on a patient that they may be able to obtain initials and social security number? Will this prevent a doctor's office, a hospital administrator through their admissions office from looking up information on a health care provider or another individual? The tracking of inquiries and investigation of those inquiries that are not followed by the input of information may help with this. I believe that a nonprofit consortium of physicians working intimately with nonprofit computing experts can answer these questions and many others.
I submit this to you as a proposal. I believe that if you are interested we can meet and discuss this proposal, and implement a plan such as bringing this to an individual at the University Computer Science Department. If you agree upon this, then after meeting with the (Continued on page 46)
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