Bill, Without federal legislation or some consensus upon formally adapted professional standards there will be much room for interpretation of ownership of patient records. I was in a situation about two years ago where I was working with a university affiliated primary clinic in which the university claimed ownership of the records and wanted open access to all patient records (they were on a fishing expedition). Clinic staff took the position that any access to the medical records other than where there was a "right to know" (e.g. defined audit) required patient consent. The judge ruled in favor of the University and levied a hefty fine against clinic staff (myself included) for blocking access to the University's records.... My point is that until the issue of ownership is clearly spelled out, questions of access are going to be left to the discretion of judges and attorneys!
Paul Juarez >>> "Bill Walton" <bill.walton at jstats.com> 04/28/03 01:32PM >>> Hi Paul, I agree completely that the ownership question is fundamental. Until recently I was under the mistaken impression that everybody agreed that the patient owned their medical records and that physicians were simply the stewards. Then I discovered that, as of the early '90's, fewer than one third of the states here U.S. even had laws that required that patients be given access to their records. So yes, I think that clearing up the question of ownership is ultimately necessary. And I'm hoping that the move to electronic form will, at least in part, both precipitate that discussion and facilitate the implementation of what I perceive to be to be the obvious answer. Best regards, Bill ----- Original Message ----- From: Paul Juarez To: bill.walton at jstats.com ; openehr-technical at openehr.org Sent: Monday, April 28, 2003 3:04 PM Subject: Re: GEHR philosophical background info 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). 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 > -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20030428/32f52639/attachment.html>
