Hi Paul,
I can't tell where you're located but if you're here in the U.S., HIPAA's
Privacy Rule went into effect on the 14th of this month and went a long way
toward resolving this problem. Your case is a good example of the reason HIPAA
was instituted. Although it doesn't clearly address the ownership question,
it's pretty comprehensive in terms of the "use and disclosure" of individually
identifiable health information. I'm not an attorney but, from my reading of
HIPAA, the situation you describe would have a different outcome in the U.S.
today.
Best regards,
Bill
----- Original Message -----
From: Paul Juarez
To: bill.walton at jstats.com ; openehr-technical at openehr.org
Sent: Monday, April 28, 2003 3:48 PM
Subject: Re: GEHR philosophical background info
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
>
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