Dear Josina You have raised an interesting discussion topic, and already had some good answers. I'll offer my own views!
I find it firstly helpful to differentiate clinical management policies from information management policies, as far as is possible. Secondly, for each, to distinguish the definition of policies and their use from the implementation of policy decisions that have been made. Thirdly, to distinguish the representation from the operationalisation of policy decisions. In the case of the logical EHR our role is primarily one of faithful representation of policy decisions that have been made. Security components will operationalise these, and although EHR systems will play a role in this, it is ideally done by generic (standards based) security components. Policies are largely defined by nations, professional bodies or health systems, who will set the rules for good/ acceptable information practice such as access rules e.g. if data can be masked from the patient. Wearing an EHR architect hat, I see my role as to design a logical model to represent the domain of plausible access policy decisions (rules) in as generic and interoperable way as possible. EN 13606 Part 4 seeks to do this, and you might wish to read its introduction section which explains the approach taken. It has been my hope that openEHR uses this standard, extending it if necessary, rather than inventing another different approach. Wearing other hats, I do get involved in UK and EU policy definition activities, where some of the more fun and controversial issues get aired, such as those raised on this list in recent days. With best wishes, Dipak Kalra UCL On 15 Dec 2007, at 18:55, Stef Verlinden <stef at vivici.nl> wrote: > > Op 15-dec-2007, om 7:37 heeft Williamtfgoossen at cs.com het volgende > geschreven: > >> In een bericht met de datum 14-12-2007 21:13:21 West-Europa >> (standaardtijd), schrijft jpfreriks at gmail.com: >> >> Dear Josina, >> >> This question should perhaps be in the openEHR legal list serve :-) >> >> From the clinical point of view I understand your question. >> However, the two use cases differ 180 degrees. >> >> The cancer use case is according to Dutch law at the edge of >> illegality. > I would even say it's over the edge > >> A Doctor is not allowed to not enter objective patient data in the >> record. He is allowed to keep personal notes on the cancer, but the >> moment he enters this information as reason for a labtest it should >> be disclosed to the patient. Anyway, the patronazing approach with >> respect to cancer has been left for over 25 years now. > Couldn't agree more. Although I can understand the idea of > protecting the patient this is really not up to a health care > provider. To give you an example: if a doctor seriously suspect > something like cancer his/her non-verbal communication will tell. > For a patient the thought, that something is so terrible that it > must be kept hidden, can be more terrifying than knowing that there > is a change that disease x is present and this must be excluded. > I've witnessed several occasions where the patient was 'protected' > and in the end the all told that they had a terrible time (one even > for 6 weeks!!) and would have loved to know upfront what was going on. > >> >> >> The information about a relative which comes to attention of a >> doctor (health professional) must be kept confidential for the >> patient. Here it would be illegal to disclose it, aside from the >> medical implications. >> >> the believing a patient or not can be handled in the problem >> oriented medical record. Dutch GP's use subjective, objective, >> evaluation, plan. The easy way forward is to list the subjective >> things a patient tells and to balance that in the objective. >> using the wording like i do not believe him/her is perhaps not >> appropriate in the medical record. > These are typical thing one would like to record as a personal note, > but one should be very careful with this. These personal notes can > start living a life on it's own. What, in my opinion, is the right > thing to do, is to 'confront' the 'patient' with this suspicion and > note this and the response of the patient in the record as > objectively as possible. Even a doctor can be biased by his/her > personal believes:-) > > Cheers, > > Stef > >> >> >> So if you want a technical solution, the two totally distinct use >> cases need to be addressed differently. >> >> In a functional requitement set we made a separate section for care >> professionals to keep confidential notes. This is then not attached >> to the individual patient's record, but is only accesible to this >> one person the doctor making the personal note (so not to other >> professionals). >> >> >> William >> >>> >>> Hello, >>> >>> I posted this message to the clinical mailing list, but think this >>> should be on the technical mailing list. Apologies if I'm not >>> correct (and please a further explanation about what is meant by >>> 'technical' ;-) ) >>> >>> I've got a question about Author Information Mandate. (an issue >>> also brought up under 'Archetype production: Types of Archetypes' >>> by Gerard Freriks.) >>> >>> What is determined about the access control of information >>> documented by the physician that s/he wants to keep obscured from >>> the patient? I believe that the whole care process is >>> characterised by a the subtle ?game? between physician and patie >>> nt, where the physician has its private thoughts and goals (whic >>> h he wants to document) but doesn?t want the patient to know, or >>> only partly. For instance, a GP might be quite sure the patien >>> t has cancer but doesn?t want to alarm the patient right away so >>> orders blood tests. (There surely are medically more correct ex >>> amples.) Others are i.e. whether the physician believes the pati >>> ent or not, or when the physician has got extra information conv >>> eyed by a relative that the patient mustn?t know about. It is ha >>> rmful to the care process and the physician-patient relation if >>> the patient has access to all of this. >>> Is there a way, in the RM for instance, that everything that is >>> under EVALUATION is kept hidden from the patient? I think this >>> should be so. There should be ?according to my opinion ? two sep >>> arate parts in the EHR: a shared part (open to, and access contr >>> olled by the patient) and a private part containing the physicia >>> ns evaluations and comments. This latter part should only be mad >>> e visible to the patient under certain (legal) circumstances, wh >>> ere the patient can order to delete certain info. >>> My question: has this been taken care of right now? If so: how? >>> >>> Josina Freriks >> >> >> >> Sincerely yours, >> >> dr. William TF Goossen >> director >> Results 4 Care b.v. >> De Stinse 15 >> 3823 VM Amersfoort >> email: Results4Care at cs.com >> phone + 31654614458 >> fax +3133 2570169 >> Dutch Chamber of Commerce number: 32121206 >> _______________________________________________ >> openEHR-clinical mailing list >> openEHR-clinical at openehr.org >> http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical > > _______________________________________________ > openEHR-clinical mailing list > openEHR-clinical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-clinical_lists.openehr.org/attachments/20071217/e98d4e1f/attachment.html>
