Patient Record is Wiki

When I think about what a patient medical record is, I picture a wiki. It is a thing that gets passed among a (closed) group of interested parties who have a need to read, change, or add to it. The elements added are as diverse as office equipment allows; printed documents, photographs, medical images, speech for physicians notes, etc. This record needs to be perpetually available to a wide audience with the ability to understand what changes were made, when and by whom. The thing would live in the web/Internet cloud on a wiki server, but could also go off-line;being carried around by a patient and then synchronized with the "master" copy on the server. Hosting this entity would include a damned reliable backup/restore capability. If the patient owned this entity (or was provided such a trusted digital service), changing medical providers would seemlessly transfer a complete medical history to the new doctor.

At this point, I look at how current wiki technology would support the diverse role-based authorization requirements for medical records. Defining the group of folks allowed to access one's records becomes more critical as the physical barriers to access are erased by the Internet. Unlike a community development project, where the organization is flat and all contribute equally, there is a regulated, and well defined set of roles and actions they are allowed to perform in medical record management. I am not aware of "carrier class" wiki implementations that include sufficient richness of authentication and access control to enable the mapping of a digital patient record via this technology. This is unfortunate given that the mapping is so natural and clean, and the benefits so compelling.

As I think of the software development required to build a wiki server capable of protecting suc h critical data, it is clear to me that many other business records would map nicely onto the wiki format and would also require rich AAA capabilities and think there is a business here.