Paul

 I've been following these discussions with a lot of interest.  So I guess
it's time for me to put in my two bits.  While I've seen a couple of
references to ownership of the medical record, I havent seen anything
definitive that defines it (e.g. patient, provider, legal custiodian of
record, etc., or some combination).

Some countries are giving legal ownership to the patient - and if it moves
anywhere it will be there. The author has copyright. Ambiguous ownership has
major advantages - and access can be legislated without solving the access
problems.

Cheers, Sam

 It seems like this question needs to be clearly agreed on before issues of
access can be identified.  (It also could be a partial solution to
distinguishing between the terms EMR, EHR, EPR).  HIPAA aside, it seems that
there may be some different legal issues about ownership that would also
have implications for access.  Any thoughts?


  >>> "Bill Walton" <bill.walton at jstats.com> 04/28/03 12:32PM >>>

  Hi Sam,

  > > BW:  This is a really interesting problem space to me.  I've been
studying HIPAA (the Health care Information Portability and Accountability
Act) and have become fascinated with the discussion over how best to balance
the needs of the various parties involved in the provision and payment of
healthcare services so as to improve the quality and decrease the cost of
health care here in the U.S..  Talk about a non-trivial problem!
Interestingly, it looks to me like all the nonsense can be traced back to
the health record and some fundamental questions about who owns it, who
controls access to it, etc.  Thanks again for sharing.  Hope to hear from
you soon.

  > > SH:  I agree - it is fascinating. Can I point you to our (original
work on this - quite philosophical) which I wrote with Len Doyal - a
professor of medical ethics in London.
  http://www.chime.ucl.ac.uk/work-areas/ehrs/GEHR/Deliverables.htm#D8

  I hate to ask this, but is there one deliverable you could point me to
that contains the philosophical stuff?  I'm up to my eyeballs right now and
I can see there's a whole bunch of good stuff at the Chime site on GEHR that
I'll have to get to asap.

  Thanks,
  Bill
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