Medibank Summary:

A patient owned medical record.   This concept was the basis of a business plan put together in 1999 and taken to venture capital markets just before Nasdaq crashed in April 2000.  The proposal was prepared with others including partners in the USA (www.technorama.net).

Copyright Dr Bulger 1999-2008 Anyone wishing to take on or revive these idea please contact me via here or at the address on the left sidebar.

Since we wrote this the NHS is now developing a multi-billion Electronic Medical Record and National "Data Spine" (NPfIT NHS Connecting for health)  In that model the State owns the medical record which in part will be held centrally (the spine), but most of the data will be held within regions LSPs (local service providers).

More about NHS Connecting for Health CfH is on http://www.careprovider.com/cfh.htm

By 2005 others such as www.medem.com are were working on similar lines that we outlined below:

The 1999 Cunning plan:

Free to patients: Our UK plan was called Medibank as people would "bank" their medical details, as they now do with their money. This service was to offer a secure international and pan-European method of holding medical records through the internet.   A patient anywhere in the world, or his authorized hospital or physician, would have access to, and be able to work on the same data. It would be free to patients and nominal for organisations to access.

Medibank works easily with Medical Data Protection Acts, by making it clear that this medical record belongs to the patient, and it is he or she who authorizes who can have access to the record and at which level.  However, like with any monetary system the patient would have to accept the "currency" of a medical record which will have an audit trail. One can own a £ coin but not deface it.

There would have been tiers of access, subject to patient acceptance. The lowest level of access allow reading of aggregated and anonymised data for reading by patient specified charities, health departments, and drug companies with patient permission. The highest level would be the full read and writing powers of the entire record by the patient's primary physician (it is not clear in the NHS Connecting for Health model who will have such "root" permission), The patient would have a masking ability and high level of authority on the record, and be able to look and add comments to the record. The patients would be to add details including their recent blood pressure monitoring or blood sugars or whatever.

All departments within a hospital, between hospitals and the family physician would be able to work from the same “live” record. When first attending a hospital the patient would give his pin number allowing the hospital to look at the record and to post their latest findings. The G.P. would identify the patient in front of him or her, when merging local clinical data with the patient's Medibank record. The patient would have a pin number.

The service would have its own "clinical software" interface, which would include drug and disease registers.  The service will be open to any other clinical and hospital software providers to post their data to the database engine, allowing their users to continue to use their interfaces and systems and local record.  The source code and methodology to do this would be open source.  (The NPfIT scraps current systems)

We would have been using the international standards that have been developed over recent years, including the development of HL7 standards and SNOMED, and Read coding systems.   There were similar ideas being developed in the USA, principally flowing from Healtheon.com and its associated companies. There are difficulties for these products to move to a European Health model. The U.K. Health Service was developing an electronic medical record that is a communication model.

We would have started by offering services charities that support patients with chronic diseases. Once the Medibank software engine has been established, numerous marketing options and other products open up. One would be a "referral engine" (now called Choose and Book by the NHS) which transfers and audits the referral process between specialists, hospitals, and general practitioners. There are many different products that can be spun off from the central system. 

Income generation is derived from offering the security of the service.  Patient access would be free. Other users, hospitals, doctors, etc would be charged say £1.00 to put the security tag onto a patient's record, which would allow access to that record. After non-use of the record over a two-year period the tag would time out.  As patients moved hospitals and changed G.P.s the churn would produce the income. Patients would have a log of who accessed their record. Patients would give permission, and may even allow charities and drug companies to access it if they so wished. This would have been the patient's record, not the Government's.

Hospital, G.P records and the patients own record would only merge into one patient record when the patient so agreed at the G.P.s surgery, by way of a pin number, and once the patient was identified. 

Dr Gerard Bulger

Archway Surgery PMS. 52 High Street, Bovingdon, Herts HP3 0HJ

01442 833380.  Fax 01442 832093                                                                                       

http://www.medibank.nhs.uk  is just this link

 © Dr Gerard Bulger March 2000 and October 2008  

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