Latest news with #patientrecords

RNZ News
20-07-2025
- Health
- RNZ News
Poor access to patient notes makes outsourcing risky, say doctors
Health staff say they are spending a lot of time tracking down patient records from other hospitals or districts. File photo. Photo: 123RF "Ad hoc" sharing of patient information between public and private hospitals is putting patients at risk, warn doctors, with the government push to outsource thousands more operations. Health NZ says it is working on a new national electronic patient data service - but insists critical records are already available to clinicians when they need it. College of Surgeons spokesperson and Christchurch urologist Sharon English said staff spent "a lot of time" tracking down patient records from other hospitals or districts. Private surgeons who also worked in the public system could at least log in and see patient notes held there, she said. "It would be different for a surgeon who works only in private, who would have to be either given access or ensure that a full copy of the notes is there. "And that's actually very hard, to get every single file." It was even more difficult extracting notes from private hospitals on patients sent back to public for post-op care, she said. Even within the public system, it was not seamless. "Just having all the public hospital systems talking to each other for a start would be fantastic." Rather than expensive outsourcing, the public system should be resourced properly to look after public patients, she said. "We see this as a work-around rather than a permanent solution." Health Minister Simeon Brown wants another 21,000 procedures outsourced over the next 12 months, on top of the more than 12,764 done so far this year. The Association of Salaried Medical Specialists - which represents senior hospital doctors and dentists - said "the scale" of outsourcing made the lack of consistent record sharing an urgent problem. Director of policy and research Harriet Wild said canny patients often showed up for specialist appointments with their own ring-binders of notes and test results. "It's really ad hoc across the board: the data sharing between primary care and secondary care, public hospitals and private hospitals, it's higgledy-piggledy and all over the place." In some cases, missing patient information could be life-threatening: "If you're talking allergies, or medications that do not mix". Outdated legacy IT systems were also a curb on efficiency in many public hospitals, she said. "Any doctor will tell you the shambles of their current hospital IT system and whether their computer can be safely updated because all their software is hopelessly out of date. "We're really operating many years in the past and it's very unsafe." Society of Anaesthetists president Morgan Edwards said access to patient records was a basic requirement. "In order to provide adequate care we need to be able to see patient notes, but what we receive from the private hospitals is a very rudimentary patient questionnaire most of the time, it's filled in by the patients. "They may say they 'get out of breath sometimes', but that could be from running a marathon or getting out of bed. So, it's really vague." Health Minister Simeon Brown wants another 21,000 procedures outsourced over the next 12 months. Photo: Nathan Mckinnon / RNZ Public hospitals within Auckland could at least see each others' records, although they were all in slightly different formats, she said. "Once you start to get patients from outside the bounds of Tāmaki Makaurau we can't see really anything. Often bloods will be visible, but not clinic letters. And the real question is, has this patient been adequately pre-op assessed? Because that information doesn't necessarily follow the patient. "For example, at Waitematā we've got a huge amount of capacity, so we're getting patients from further and further afield all the time, like from Northland, but we can't see their notes very well." Patients who had not been assessed properly and were too sick to be treated in the private system sometimes had their surgery cancelled, which allowed "inefficiency to creep in". "While the outsourcing has got some potential huge benefits, it's also just so expensive, that in many ways it does feel like a short-sighted solution. "It's difficult to jump on board with a concept that is not the most cost-effective use of health money, if we're looking at a 20-year plan." She said anaesthetists raised the patient record problem with the Minister at a recent meeting. "He was also surprised at this information, it was new information to him. We're now trying very hard to meet with Health NZ to ensure there is consistency of process across the country." Health NZ spokesperson Cath Cronin said outsourcing planned surgical care to private hospitals to reduce wait times was "not new". "Patient safety and the protection of patient information is taken very seriously for anyone treated in public or private facilities. There are multiple checks and balances built into the referral and surgical treatment process." All decisions regarding which patients were appropriate to receive care in private hospitals were made by the relevant specialist multi-disciplinary clinical team. "Critical patient information will always be available to the treating clinicians. A surgical operation will not proceed without the surgeon and anaesthetist first reviewing the patient's clinical record. If the surgeon and anaesthetist are not comfortable with the information they have, the patient will not be accepted for surgery." Health NZ was working on a new electronic patient data service called the Shared Digital Health Record to "help" secure sharing of health information nationwide, and was looking to centralise radiology and diagnostic results data, she said. Private Surgical Hospitals Association chief executive Chris Roberts said outsourcing had been going on for decades and there were "long-established processes in place to protect patient safety and privacy". Private hospitals already carried out 70 percent of elective operations, and more than 90 percent of ACC-funded operations. Outsourcing had been "ad hoc and varied" until now, he said. "What is now being proposed by the Minister and Health NZ is a more consistent approach." Regarding information sharing, there could be "some legacy issues from the district health board model", which allowed for different approaches in different regions". "But Health NZ is now providing national guidelines. It is for Health NZ to comment on their processes and requirements." Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.


Medscape
18-07-2025
- Health
- Medscape
On Retiring From the Practice of Medicine
Last week, I retired from practicing medicine. My medical work stopped 3 years ago, but now retirement is official. To retire, all I had to do was submit a one-page form to my state medical licensing board: name, address, email, and two boxes to check. One said that my patient records would remain accessible. The other affirmed, 'I am not aware of any open or reasonably anticipated complaints to the Board against me.' (Complaints about any physician can be submitted by email, so the most a doctor can promise is that nothing is 'reasonably anticipated.') I had decided not to renew my license this year, to avoid fees and continuing education requirements. My first medical license was issued over 50 years ago, when I was an intern. For 42 of those years, I practiced medicine in my own office. The end of my office work was sudden. I had already cut back working hours when COVID struck. On Friday, March 13, 2020, I left my office and never came back. At first, I stayed in touch with staff by phone and saw patients online a few hours a week. That was frustrating and almost useless. Remote technology back then was poor, and the visits achieved little. Some professionals who retire wonder whether doing so will cause them to lose their identity. I have found that what identity I had seems to still be there. Practicing medicine was a great privilege. Being able to help, guide, or reassure people in their times of need struck me then, and strikes me now, as a most worthy way to spend one's working life. I regret none of it. I just don't want to do it anymore. Consulting with patients, I met many people I would never have otherwise come across. They hailed from towns nearby and from countries around the world. Many shared stories I had never heard, some of which I could not have imagined. In this way, I got to know my patients, at least a bit. Over time, I grew to know some of their children, even their grandchildren. There were times when getting to know them, what they did, how they thought, had a direct impact on managing their medical condition. Most often it did not. Still, it always seemed to me that caring for people is better done if you know them, at least to some extent. Through the years, nothing changed my mind about this. Throughout, I remained grateful for the efforts patients had to make to see me. They fought traffic, scrounged parking, struggled with officialdom over referrals, sat in my waiting room, all for the honor of hearing what I had to say. To the end, I never stopped wondering whether what I had to offer was worth their effort. I would like to think that, at least for many, it was. Looking back, the practice of dermatology, and of medicine in general, has of course changed a great deal. The big change in dermatology has been the emphasis on cosmetic work, which was not part of what dermatologists did when I started out. Lasers and cosmetics have lent our profession more glamour, and for many who practice it, a different emphasis. Cosmetic clients ask different questions and have different expectations from patients with purely medical concerns. I got involved a bit with cosmetic dermatology before I really understood what it entailed, but my heart was never in it. Cosmetics remained a small part of what I did. The big change in medical practice in general is the ubiquity of electronic medical records (EMRs). The advantage these offer dermatology is the ease with which photographs and other visual records can be incorporated into visit notes. These offer much-needed precision in identifying and following lesions that was unavailable in the old days of scribbled paper charts. EMRs have of course also changed the texture of practice life, demanding hours of record-keeping drudgery, much of it in the service of recording data of dubious significance. The third change worth mentioning is the acceptance, by the medical profession and the public, of mid-level providers, nurse practitioners and physician assistants (PAs). I worked with PAs for 20 years. Their competence, and interest in traditional medical dermatology, was a source of much professional satisfaction for me and of great value to my patients. Retirees I met, among my friends and patients, sometimes told me they were unhappy, not because they missed their work but because they missed the people they had worked with. In medicine, those are staff and colleagues. They share an intimate knowledge of the small charms and frustrations that fill working days: the cranky gent who sends the staff flowers; the insurer who will not cooperate; the regular patient who cannot manage to show up on time, or at all. As I mentioned, many of my own colleagues were PAs whom I trained myself and worked alongside for years or decades. All were capable; one was extraordinary. At times, she and I shared a heart-to-heart about the work we did together and how we felt about it, what it was like to live with a sense of unending responsibility, challenged at times by spasms of self-doubt. What if we had not offered advice in a way the patient could accept? What if well-laid plans did not turn out well, or if our suggestions seemed on reflection to be ill-advised or just wrong? Life offers few chances to have fully honest talks like those, with someone who truly understands, on matters that cut to the core of the soul. I will cherish with gratitude the memory of those discussions. Some people who think about retiring worry about needing to endure going-away parties. Along with food and drink and perhaps a parting gift or memento come speeches and sentiment, which may spill over into sentimentality. If such are the rites of passage for leaving an office, what must they be like for leaving a profession? While recall is fresh, I can share my own experience. The acceptance of my application for retirement status came by email:


Telegraph
22-06-2025
- Health
- Telegraph
China increases cyber attacks on hospitals to ‘humiliate' Taiwan
In early February, staff at Taiwan's MacKay Memorial Hospital were attempting to access patient records when they noticed a problem. A virus had ripped through their computer system, causing hundreds of computers to crash and blocking their access to patient records. It was the work of a 20-year-old Chinese hacker named Lo Chengyu, known as 'Crazyhunter', who had stolen 16.6 million patient records, according to police. Lo demanded a ransom of $100,000, but when the hospital refused, he set up a website where he released the victims' names and threatened to post their records as well. However, security experts managed to expel the virus with no money exchanged. Since February, Taiwan has experienced an increase in the number of cyber attacks against hospitals, along with local government and tax offices, with the majority coming from China. China claims Taiwan as part of its territory, which the government in Taipei firmly rejects, and has threatened to invade the island on multiple occasions. While Beijing has yet to use full-blown force, it has employed a wide range of 'grey-zone' measures, which fall short of open warfare but seek to coerce Taiwan and grind the country down ahead of a possible attack. Over the last three years, Taiwan has made significant strides in developing mechanisms to protect itself against Chinese grey-zone attacks, but many vulnerabilities remain, especially in cyber space. 'They have no capability to attack our defence department website or foreign affairs website or the Ministry of Digital Affairs website,' said Herming Chiueh, the country's deputy minister of digital affairs. 'So they need to shift their attack to our weak part, which are hospitals,' he said during an interview in June. Mr Chiueh's rise to the job reflects the rapid growth of Taiwan's cyber security team and its expanding capabilities. He assumed the role in 2022 – the same year the ministry was founded – taking leave from his work as an engineering professor at a university in Hsinchu, Taiwan's main technology hub. In three short years, Taiwan's cyber security mandate has grown from a 20-person team within the executive branch to nearly 500 people spread out across the entire government as the country faces a rapidly intensifying crisis. Last year, the island experienced an average of 2.4 million cyber attacks daily – double the daily average in 2023 – with 80 per cent targeting government agencies. While data for the first half of 2025 is not yet available, Mr Chiueh said the amount has only continued to increase. This is partly because Taiwan now has more sensors that are able to detect attacks and partly because China has thrown so many resources into expanding its cyber technology and ability to launch cyber attacks. Attacks on hospitals Hospital networks store some of the most personal information on a person – from family history to detailed accounts of any sicknesses, making them prime targets for an adversary. The attacks against hospitals, which have been primarily centred on obtaining personal data, seem to be an attempt by China to show off its cyber strengths. They are likely part of a multi-pronged effort by China to intimidate Taiwan by highlighting its vulnerabilities, as well as to lay the groundwork for a potential future invasion. 'The only purpose is to try to humiliate and show that they have the capability to disturb us as a society,' said Mr Chiueh. He explained that the hackers will often post the data that they harvest on the dark web as a trophy, similar to what Lo threatened to do with the data from MacKay Memorial Hospital. Lennon Chang, a cyber security expert and associate professor at Deakin University in Australia, said that by posting sensitive information online, Chinese hackers could instil doubt over the government's ability to protect its citizens. 'It could create negative impressions or images of leaders in Taiwan,' he said. Hospitals are also an integral part of a country's resilience during wartime. An adversary's ability to interrupt or incapacitate a target's healthcare network during an assault could provide them with a significant advantage. 'They could be trying to reveal the vulnerabilities of these hospitals so that during critical times they will be able to hack into and shut down the system or create a mess within the hospitals,' said Mr Chang. Seven 'cyber armies' Taiwan has traced the majority of its cyber attacks back to China and the Ministry of Digital Affairs suspects that the Chinese Communist Party is behind many of them, although the exact proportion is unknown. Mr Chiueh explained that China has seven 'cyber armies' – two of which are focused exclusively on Taiwan, while, by contrast, only one is focused on the United States. In April last year, China established the People's Liberation Army Cyberspace Force – the latest iteration of a cyber warfare military unit, which it runs in secret to maintain 'national cyber sovereignty'. Mr Chiueh said: 'If you compare cyber attacks with the US and Taiwan federal governments, our government gets seven times the number of attacks.' The Ministry of Digital Affairs' monthly cyber security report from April found that the most common type of attack was information collection, followed by intrusion, which mostly involved unauthorised access to systems. One type of intrusive attack that the ministry has followed closely are distributed denial of service (DDoS) attacks, which flood servers with traffic to shut them down. These attacks have increased six-fold in the last three years, with a notable spike following Nancy Pelosi's visit to Taiwan in August 2022 while she was the speaker of the US House of Representatives. Ms Pelosi was the first high-level official to visit Taiwan in 25 years. China saw the visit as a sign of US support for the island and responded with a wave of grey-zone tactics, which have continued up to now. 'With DDoS attacks, there is a pattern. The attack will begin at 9 o'clock in the morning, then there will be a lunch break from 12 o'clock to 1 o'clock, then the attacker will end at 5,' said Mr Chiueh. 'The working hours are in the same time zone as us.' Taiwan has also traced the IP addresses of many of the hacks to compromised devices known to be connected to the Chinese military. The types of information targeted in many cyber attacks also suggests that the Chinese government is responsible. Chinese hackers have been using 'very sophisticated social engineering', such as phishing software, to target the personal devices of 'specific government officials' and 'collect lots of intel around these people,' said Mr Chiueh. 'The reason they need to collect data is to cyber attack our critical infrastructure or use the information they collect to spread disinformation or misinformation. Both of these are the behaviours of a hostile enemy,' said Mr Chiueh. Underwater vulnerabilities While cyber security remains a focus for Taipei, another rising grey-zone threat is the country's undersea submarine cables. Taiwan relies on 24 underwater cables – 14 international ones and 10 domestic – to carry 99 per cent of its internet traffic. These cables are normally buried at least a couple of metres below the sea bed to protect them, but Chinese vessels continue to find ways of dredging them up. Since 2019, there have been dozens of incidents involving Chinese ships – often fishing or cargo boats – which have destroyed the cables and cut off internet access to entire islands. In 2023, two boats cut the cables providing internet to Taiwan's outlying Matsu Island, leaving 12,000 residents without connection for almost two months. Beijing has routinely denied any responsibility for these incidents, claiming they were either accidents or that the damages were caused by natural decay. Mr Chiueh said the likelihood of an attack against Taiwan's undersea cables today is higher than that of a large-scale cyber attack because 'the cost is much higher than to hire a few boats to cut our subsea cables'. Taiwan has taken measures to deter any kind of destruction. In 2023, after the Matsu incident, Taiwan amended its telecommunications law to criminalise undersea cable attacks with a punishment of one to seven years in prison and a fine of up to NTD$10 million (£250,000). Last week, Taiwan sentenced a Chinese boat captain to three years in prison for damaging an undersea cable linking Taiwan's main island to the outlying Penghu Islands. However, stronger punitive action is not the only way that Taiwan has been responding to China's growing pressure – the island has also been improving its own resilience and deterrence capabilities. Mr Chiueh said that the two cables to Matsu were damaged again earlier this year due to natural causes, yet instead of waiting six weeks, residents were back online almost immediately thanks to new microwave back-ups installed on the island. Taiwan's ability to deter cyber attacks is also improving. While the number of attacks increased this year, there were fewer breaches compared to last year. But experts caution that the country still has a way to go. Mr Chang said that if China were to launch a full-scale cyber attack tomorrow, Taiwan would 'definitely be in a lot of trouble'. 'Taiwan has built quite a good capacity in cyber resilience in the past few years, but there are still areas that need to be addressed,' added Mr Chang.
Yahoo
03-06-2025
- General
- Yahoo
Hundreds of Manx patients affected by data error
More than 430 patients on the Isle of Man have been subject to a data error resulting in their home addresses being changed to UK ones, Manx Care has said. The island's healthcare provider said NHS England had incorrectly recorded temporary UK residences as permanent addresses for island residents who were receiving treatment there. A spokeswoman said that so far about 446 patients had been affected, with further cases likely to be confirmed as "awareness increases". She said Manx Care was "actively collaborating" with UK healthcare bodies and integrated care boards to "improve how address changes are managed, particularly for patients moving between the Isle of Man and the UK". NHS systems on the Isle of Man and in the UK work independently, but data is shared when address changes are made. The Manx Care spokeswoman said: "In some cases the UK system assumed a permanent relocation rather than a temporary visit." This led to "unintended updates to patient records", she added. Manx Care said it was contacting GP practices to verify permanent addresses to all of those affected by the error and had reiterated "the importance of not replacing records" to UK health providers. Meanwhile, the health body has urged anyone who has been treated in the UK and expected correspondence from Manx Care, to get in touch with their GP practice to "review your records". Potential impacts on care could mean people miss or have delayed invitations for routine screenings or appointments at Noble's Hospital. Manx Care said that despite the error, patients would not lose their places at their Manx GP practice. The healthcare body apologised for "any confusion or disruption" and said people's "health and peace of mind [were] top priorities". Read more stories from the Isle of Man on the BBC, watch BBC North West Tonight on BBC iPlayer and follow BBC Isle of Man on Facebook and X. Rising costs ignite review into off-island care Society outlines concerns over Manx Care mandate Patients 'in limbo' over health cuts, MHK says Manx Care NHS England


BBC News
03-06-2025
- General
- BBC News
Hundreds of Isle of Man patients affected by NHS data error
More than 430 patients on the Isle of Man have been subject to a data error resulting in their home addresses being changed to UK ones, Manx Care has said. The island's healthcare provider said NHS England had incorrectly recorded temporary UK residences as permanent addresses for island residents who were receiving treatment there. A spokeswoman said that so far about 446 patients had been affected, with further cases likely to be confirmed as "awareness increases".She said Manx Care was "actively collaborating" with UK healthcare bodies and integrated care boards to "improve how address changes are managed, particularly for patients moving between the Isle of Man and the UK". NHS systems on the Isle of Man and in the UK work independently, but data is shared when address changes are made. The Manx Care spokeswoman said: "In some cases the UK system assumed a permanent relocation rather than a temporary visit."This led to "unintended updates to patient records", she added. Missed appointments Manx Care said it was contacting GP practices to verify permanent addresses to all of those affected by the error and had reiterated "the importance of not replacing records" to UK health the health body has urged anyone who has been treated in the UK and expected correspondence from Manx Care, to get in touch with their GP practice to "review your records".Potential impacts on care could mean people miss or have delayed invitations for routine screenings or appointments at Noble's Hospital. Manx Care said that despite the error, patients would not lose their places at their Manx GP healthcare body apologised for "any confusion or disruption" and said people's "health and peace of mind [were] top priorities". Read more stories from the Isle of Man on the BBC, watch BBC North West Tonight on BBC iPlayer and follow BBC Isle of Man on Facebook and X.