The real me

[Margaret Ford] Knowing some of the vulnerabilities of the UK’s ‘Connecting for Health’ programme, I have accepted that my medical details may well become a matter of public record. Still, my nephew received outstanding emergency treatment as a result of his records being available on the backbone, so I’ve been keeping an open mind.

However, one aspect I hadn’t expected is the hypnotic effect of technology. At a recent routine check-up the blood pressure monitor failed, so I was told that my pulse was faulty. No effort was made to investigate this faulty pulse, but it did excuse the machine’s inability to perform. When I gave the nurse a brief history of my condition, she looked puzzled and told me that I must be mistaken because otherwise the doctor would have included those details in my notes. Unfortunately my doctor was away, and so unable to confirm.

As the nurse stared intently at the screen, it became clear that this digital representation of me was much more real to her than my physical presence. I persevered, reasoning that her original training must have included living, breathing human beings. Finally, sensing that this was a losing battle and remembering posters promising dire consequences for anyone upsetting surgery staff, I decided to give up the struggle. With no medical consequences, it was only a minor irritation but did give me a brief insight into the powerlessness and alienation resulting from digital misrepresentation. Even without identity fraud, it was not a very happy experience.

Clearly a mechanism for patients to contribute to their own notes might help. The new German health card, released for general use this year, might provide an example: patients can maintain a ‘disease diary’ alongside their detailed medical history, all stored on a smartcard, with ‘security numbers’ required from both patient and doctor to gain access. Although some have expressed security concerns, the main drawback appears to be the cost of roll-out (currently estimated at €1.6bn).

Historically the German health card has been very simple, with only name, date of birth and insurance company included. It may be that the German authorities gained inspiration from the rich functionality of the French Carte Vitale, which has itself recently been updated with a photograph to combat fraud. If the European Health Insurance Card is to become both ‘smart’ and interoperable, these examples may provide a valuable model.