Hi Paul, There was likely an assignment executed by the Patient to the University covering ownership, the assignment required prior to the Patient being treated at the University-affiliated Clinic. These are tricky as are arbitration agreements, usually found before or after the assignment. Did you have an attorney review it?
In New York, my Grandmother assigned my Grandfather to a University research clinic to be able to access the latest in cancer research. He never made it out of the Hospital. One can assign their right to receive income from a property to another and the assignment, if legal, will be upheld. Our legal systems may produce strange results in such cases. My Grandfather lived for almost one year thereafter. Some legal systems protect Patient records and privacy; others do not. Bottom line is you give the Clinic only what is necessary and when it is necessary. The assignment problem is easily handled and best described by an attorney. Since my focus is Patient Centered Healthcare, which requires some form of Secure Data Store, the records are owned by the Secure Data Store. You are very right concerning the involvement of judges and attorneys. The legal issues must be handled up front. -Thomas Clark . ----- Original Message ----- From: "Paul Juarez" <[email protected]> To: <bill.walton at jstats.com>; <openehr-technical at openehr.org> Sent: Monday, April 28, 2003 1:48 PM Subject: Re: GEHR philosophical background info > This is a MIME message. If you are reading this text, you may want to > consider changing to a mail reader or gateway that understands how to > properly handle MIME multipart messages. > > --=_C09F5EA8.52335635 > Xontent-Type: text/plain; charset=US-ASCII > Content-Transfer-Encoding: 7bit > > 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 > > > > --=_C09F5EA8.52335635 > Xontent-Type: text/html; charset=ISO-8859-1 > Content-Transfer-Encoding: 8bit > Content-Description: HTML > > <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> > <HTML><HEAD> > <META http-equiv=Xontent-Type content="text/html; charset=iso-8859-1"> > <META content="MSHTML 5.50.4134.600" name=GENERATOR></HEAD> > <BODY style="MARGIN-TOP: 2px; FONT: 8pt MS Sans Serif; MARGIN-LEFT: 2px"> > <DIV><FONT size=1>Bill,</FONT></DIV> > <DIV><FONT size=1></FONT> </DIV> > <DIV><FONT size=1>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! </FONT></DIV> > <DIV><FONT size=1></FONT> </DIV> > <DIV><FONT size=1>Paul Juarez</FONT></DIV> > <DIV><BR><BR>>>> "Bill Walton" <bill.walton at jstats.com> 04/28/03 > 01:32PM >>><BR></DIV><FONT face="MS Sans Serif" size=1> > <DIV><FONT face=Arial size=3>Hi Paul,</FONT></DIV> > <DIV> </DIV> > <DIV><FONT face=Arial size=3>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.</FONT></DIV> > <DIV> </DIV> > <DIV><FONT face=Arial size=3>Best regards,</FONT></DIV> > <DIV><FONT face=Arial size=3>Bill</FONT></DIV> > <BLOCKQUOTE > style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px"> > <DIV style="FONT: 10pt arial">----- Original Message ----- </DIV> > <DIV > style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"><B>From:</B> > <A title=JuarezPD at wmmcpo.ah.org href="mailto:JuarezPD at wmmcpo.ah.org">Paul > Juarez</A> </DIV> > <DIV style="FONT: 10pt arial"><B>To:</B> <A title=bill.walton at jstats.com > href="mailto:bill.walton at jstats.com">bill.walton at jstats.com</A> ; <A > title=openehr-technical at openehr.org > href="mailto:openehr-technical at openehr.org">openehr-technical at openehr.org</A > > </DIV> > <DIV style="FONT: 10pt arial"><B>Sent:</B> Monday, April 28, 2003 3:04 > PM</DIV> > <DIV style="FONT: 10pt arial"><B>Subject:</B> Re: GEHR philosophical > background info</DIV> > <DIV><BR></DIV> > <DIV><FONT size=1>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?</FONT></DIV> > <DIV><BR><BR>>>> "Bill Walton" <bill.walton at jstats.com> > 04/28/03 12:32PM >>><BR></DIV> > <DIV><FONT face=Arial> > <DIV><FONT face=Arial><FONT color=#0000ff>Hi Sam,</FONT></FONT></DIV> > <DIV><FONT face=Arial><BR>> > 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.<BR> <BR>> > > 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. </DIV> > <DIV><FONT > face=Arial>http //www.chime.ucl.ac.uk/work-areas/ehrs/GEHR/Deliverables.htm#D8<BR> <BR> <FONT > color=#0000ff>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.</FONT></FONT></DIV> > <DIV> </DIV> > <DIV><FONT color=#0000ff>Thanks,</FONT></DIV> > <DIV><FONT > color=#0000ff>Bill</FONT></DIV></FONT></FONT></DIV></BLOCKQUOTE></FONT>>< /BODY></HTML> > > --=_C09F5EA8.52335635-- > - > If you have any questions about using this list, > please send a message to d.lloyd at openehr.org - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
