Bill Walton wrote:

>
> > > BW:  Further, it looks like the EHR access history should include 
> reads as well as writes.  That way, the trail would lead to the 
> providers that have, with permission, made copies of the EHR within 
> their own systems.
>  
> > SH: True - it will only be able to be stored as an HTML rendition 
> unless there is an extract in openEHR - but you are right - this could 
> be saved - this is difficult to police. 
>  
> Oops!  I'd assumed there would be extracts in openEHR.  HIPAA 
> specifies, under the Transaction Rules that go into effect in October 
> of this year, a number of EDI transactions between systems that would 
> require this.  HTML will not be sufficient.

Can anyone clarify this bit of the debate - I have lost track of what is 
being said here!

>  
> I'm taking this to mean that there will be configurable permissions on 
> type of access.  Yes?

yes - probably quite sophisticated ones.

>  > SH: Research access will be via the kernel with an approved program 
> unless it is one-to-one reading of records when the patient's consent 
> is required anyway.
>  
> Hmmm....  Again, perhaps a difference at the national level.  Research 
> here is the U.S. typically requires extracted data to be 
> transferred from a physician's system to the research organization's 
> system.

both scenarios are equally ok. I would also have expected the one Bill 
mentions to be more likely - especially as data transformation and 
anonymisatino are often needed.

- thomas beale



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