Hi Thomas, Thomas Beale wrote:
/snip/ > So. What do we know? > - role-based access control is required. To make it work properly in a > shared care community context (e.g. a hospital, 50 GPs, aged care homes, > nursing care, social workers etc etc) then the roles need to be defined > congruently. I seem to remember some Canadian project coming to the > conclusion that really the roles need to be defined the same across the > entire (national) health care system. I think this is both correct and a > the same time unrealistic. With all due respect, Thomas, it it's unrealistic then, IMO, it can't be correct. (Pragmatism R Us ;-) ) I'd like to offer food for thought. The fundamental assumption at work here seems to be that care givers will access the same system, thus driving the need for all users of the system to be assigned roles that are defined congruently. Let's consider an alternative model. When I travel from the U.S. to the U.K., I (the physical being) move from one socio-cultural-legal model to another. That does not change who / what I am, but it does change my behavior because I operate under a different set of norms and mores in the new environment. I accept new forms of interaction and find that familiar forms are no longer available. Why should it be any different for the information about me than it is for me? If we work from a perspective that posits that health information will move from system to system and be used / modified based on the rule sets in place within the various systems, does that make the problem more amenable to solution? > I think we will be able to find ways of > having diversely defined roles without every health care facility having > incompatible definitions of "consultant", "treating physician" etc. > Bernd's work on this area is pretty detailed. I thank Bernd for opening my eyes to what should have been obvious to me at a much earlier stage. The security problem with EHR systems is fundamentally the same problem faced in OLAP databases. Or perhaps I should say that it's the OLAP security problem with a twist. At least OLAP databases are typically confined to one environment / business. It's clear that the EHR problem is more difficult in that EHR's must, IMO, be capable of moving between environments. Perhaps, by requiring a more generalized solution, the EHR problem will actually be easier to solve. I don't know if you've checked out Mike Mair's paper but it implicitly poses a very interesting question. "Is a biologically-based security model fundamentally better aligned with the needs of an information system about biological entities than alternative models?" I'm hopeful the list will have some comments on Mike's paper. I think the question is worth some thought / discussion. /snip/ Best regards, Bill - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
