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Hi Ed,
One needs to distinguish between System Designers and Application
Designers and both can be
subdivided further, e.g., Fault-Tolerant. System Designers 'handle' the
data and information;
Application Designers 'handle' the content.
Understanding the difference between data and information
Hi Arild,
Another site is the MIT Group on Clinical Decision Making: [
http://medg.lcs.mit.edu/ ].
... a research group dedicated to exploring and furthering the
application of technology and artificial intelligence to clinical
situations. Because of the vital and crucial nature of medical
Hi Bish,
Periodic and immediate 'Bio' identification would satisfy certain
security requirements
re authenticity, e.g., official documents (e.g., post surgical release).
Your comment re
'thumb imprint', or scan, provides a more secure means of authentication
that may be
required.
Requiring
Hi David,
Suggest you look at the creating systems for Patient-centered and controlled
Healthcare Records that incorporate portions of the Practitioner created
and maintained
Healthcare Records.
Regulations and other 'governance' was designed primarily to target
Practitioners and the
practice
Hi Gerard,
Some possible applications and sources:
'coronary and stroke event rates in the population' (project-oriented)
http://www.ktl.fi/publications/monica/demoqa/demoqa.htm#Discussion
Deaths - lethal Dosage
http://www.ohd.hr.state.or.us/chs/pas/ar-tbl-1.pdf
UN Statistics
Hi Sebastian,
Correct!
The lifetime of a digital signature is some environments is quite short,
which is why one
gets to change it periodically. However, for permanent records the
digital signature of the
creator can remain fixed since the record is fixed.
You are correct re data
Hi Gerard,
Wish you were right.
Comment: Changes in the legal system can be used to prove the continuing
existance
of Evolution.
Regards!
-Thomas Clark
Gerard Freriks wrote:
Life is simple.
Once we physicians know what to ask and why.
Gerard
-- private --
Gerard Freriks, arts
Hi Bob,
An 'international awareness' must be developed in advance and evolved
continuously.
The EHR community is part of the bedrock of future Healthcare policies,
procedures
and practices. It must be based on facts and incorporate all available
information.
The Legal community requires facts
Hi David,
Significant problem! However, software configuration management has
solved this
before. In the Legal or secure OS environments the contributions of
individuals are
in fact part of the record even through the 'end-game' is an update that
merges the
contributions of all, e.g., a
Hi All,
Demographics (characteristics of a population) is one element of a
larger more complex
problem which may be labeled 'Patient Categories and Classifications',
or simply
'Patient Boxes'. Conceptualizing the postal annex analogy, the
interesting part comes when
the available information
Hi All,
This is an interesting case that prompts questions regarding EHRs
surrounding death
of a Patient. It also serves to illustrate how goverment can alter what
should be a rather
clear, concise medical event that must at some time and in some form be
entered into
the EHRs.
The issues here
Hi Karsten,
The *definition* of a lightyear is *fixed*, i.e., the 'distance light
travels in a year',
and not directly measurable, e.g., tag a photon and measure its progress
thoughout
one year.
The problem is that the *distance* each photon travels in a year may not
be the
same. You are
Hi All,
Light has successfully been slowed and stopped, i.e., encapsulated in a
material) for a
significant period of time. Lasers are used to send it on its way.
Destroyed a niche
in my memory banks when it was announced. Do not see a substitute for
the 'old-light',
aka the 'new-light'.
Hi All,
One should include mental age as well. EHRs should not presume a
Patient's mental
capabilities closely track their physical age. This would be a recipe
for disaaster
under its own terms since 'young' physical age and 'senior' physical age
represent
gray areas regarding mental
Elkin, Peter L., M.D. wrote:
Dear Thomas,
I favor the episode being a single point of audit (regardless of the
timeframes at which an episode starts and stops). So all encounters
and non-encounter events would indeed be part of an episode of care.
This brings continuity to the
Hi All,
'hierarchical', at a minimum, shouldn't be used to describe
physical/chemical processes, e.g., flight dynamics and
control of the 747 I just rode. Space has to be included in this; OK
throw in the Universe we are in and all the
others we do not know about.
The brain, as a chemical
Hi Tim,
Security policies are included as are implementation approaches.
Regards!
-Thomas Clark
Tim Churches wrote:
On Wed, 2004-03-10 at 19:10, Thomas Clark wrote:
Hi Tim,
Might want to add:
Computer Security Basics
http://www.oreilly.de/catalog/csb/toc.html
IEEE; Compartmented Mode
Hi Tim,
One I failed to include is:
RFC 3586 - IP Security Policy (IPSP) Requirements
http://www.faqs.org/rfcs/rfc3586.html
Some of the included links support searches, e.g., The CMU link returned
over 2200
hits on a search for 'security policy'. Lots of policy-related
information that is
Hi William,
YES!
From the IT viewpoint there will be limited responses on the 'health
oriented search engines' that would be of significance to the
operational aspects of a global distributed co-operative information system.
Should I require detailed information on the proper content of an
Hi Tim,
Pieces of the 33 hits are included below:
-Sarcomatoid carcinoma of the cervix
-An evaluation of the usefulness of two terminology models for
integrating nursing diagnosis concepts into SNOMED Clinical Terms
-Improved coding of the primary reason for visit to the emergency
department
Hi All,
Submitted a request to the Uniform Law Commissioners
(http://www.nccusl.org/nccusl/DesktopDefault.aspx)
to consider a project for ELECTRONIC HEALTHCARE RECORDS. The next
meeting will be in January, 2004.
If a project is approved the Commissioners will address a Uniform Code
for the 50
Hi,
Is anyone from Portland, Oregon on this list?
-Thomas Clark
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If you have any questions about using this list,
please send a message to d.lloyd at openehr.org
Hi Chris,
Privacy is a major 'topic'. Others include 'security' onsite, in
transmission, retention, archiving, copies, modifications and signatures.
Some jurisdictions have well-developed laws (and model code as well)
covering electronic records in eCommerce (includes the US and Clinton's
Patrick Lefebvre wrote:
Hi All,
--- (...)
Been off looking at some operational considerations associated
with supporting, maintaining and updating global EHRs.
The following types of users were considered:
1)CREATORS
2)REVIEWERS
3)ADMINISTRATORS
4)CERTIFIERS
This idea of
Hi Norbert,
Excellent example! It is easy to imagine that a poll taken in the US would
show that a majority of the public would believe this could not happen.
-Thomas Clark
- Original Message -
From: norbert Lipszyc i...@club-internet.fr
To: Denis Nosworthy Denis.Nosworthy at
Hi Dennis,
The personal card is a great approach. Unfortunately there are
many people who will not have access to the cards. Alternate means
could be employed to handle the IDs.
Multiple ways of generating/retrieving the Patient's ID should be
available. The smart card is a good approach for
Hi All,
With a background in fault tolerant computing I have a built-in penchant for
distributed files that are exact/backup copies of a master. Works wonders
for
financial transactions.
I don't believe that this model fits EHRs especially since one can conceive
of
parallel, e.g., close
Hi Chris,
One thought to keep in mind regarding:
The EHR efforts seem to want to standardize both the data AND
the horse it rode in on.:
The DATA embedded in an OpenEHR standardized system can be both
extracted and modified. My hunch is that the final OpenEHR standardized
system may still be
Hi Chris,
Great response!
Would like to learn what the US Providers want and need from a system
like the proposed OpenEHR project. Contributors to the project are at
liberty to publish; but the remaining, quite numerous, Providers may well
be unaware of the existence of such projects and unable
Hi Thomas,
Thanks for the response! The regional approach serves the project well
initially.
The original post should have included some idea of what I think a 'tool'
would be.
Top-down, it should permit a proper user to identify the subject (difficult
in some
cases, e.g., where only an infant
Hi All,
COMMENTS (SHORT LIST):
1)TOOLSETS
Should support:
a)Humans (practitioners, administrators, support personnel, patients and
their support groups)
This should support visualizations, e.g.,
VIEW/MODIFY/JOIN/SEVER/PARTITION/INTEGRATE,
for a human operator
b)local/remote software
Hi All,
The following link is to an article appearing in the San Francisco Chronicle
online version, May 14, 2003 entitled:
LAZARUS AT LARGE
Kaiser exporting privacy
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/05/14
/BU307139.DTLtype=tech
Unfortunately this has been
Hi Gerard,
There has to be medical/Patient/healthcare records and related documents but
they must be linked.
Storage must be provided for the above, permanent, temporary and
intermediary (e.g., dialog
between practitioners). Event-based entries into medical/Patient/healthcare
records would be
Hi All,
The following is a link to the NIST Automated Security Assessment Tool.
For OpenEHR one tool will be insufficient. Something similar is feasible for
the
low-level (network/system) OpenEHR project.
http://csrc.nist.gov/asset/
-Thomas Clark
-
If you have any questions about using this
Hi Karsten,
Comments in text.
-Thomas Clark
- Original Message -
From: Karsten Hilbert karsten.hilb...@gmx.net
To: openehr-technical at openehr.org
Sent: Thursday, May 08, 2003 2:04 AM
Subject: Re: openEHR security; Directed to Thomas Beale
Tracking is super-important. Include the
Hi Matt,
Comments in text.
- Original Message -
From: Matt Evans m...@totalise.co.uk
To: 'Thomas Clark' tclark at hcsystems.com; openehr-technical at
openehr.org
Sent: Monday, May 05, 2003 7:09 AM
Subject: RE: openEHR security; Directed to Thomas Beale
Hi Thomas,
I forgot I had set
Hi Tim,
Never trusting the record is in itself justification for OpenEHR and
interfacing it
with all other EHR/EPR/EMR systems. I do not 100% trust the contents of the
records supported by the EHR/EPR/EMR systems. The basic rationale is that
the information is generated by related devices and
Hi Tim,
Do not have a link handy but I do recall that the EMR discussions in the NHS
introduced this and discussed it at length. Structuring data entry format
went
a long way toward improving it. I'll see if I can come up with a link.
-Thomas Clark
- Original Message -
From: Tim
Hi Gerard,
Record Level Data Security has little to do with legal, social control and
organizational aspects.
I agree that these are important, and in many cases more important, than
record level data security. They are more complex issues that are dependent
upon factors varying from culture to
Hi Gerard,
Good list of requirements. My question concerns contact between Healthcare
Practitioners and others which may include geographically remote locations
and roving, e.g., in-hospital via wearable or hand-held units. This contact
would extend beyond that of the Practitioner-Patient.
A
Security begins at the data storage level. Unless it can be protected at
this level more sophisticated techniques applied to transmission and content
will not be as effective as desired.
Three common approaches are:
1)Data security
2)Data management and
3)Access to storage media-resident data,
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