Ownership and access of the health record

Work Item on Ownership and Access of the Health Record (Second Draft 23 October 1999)

Prepared by the New Zealand Delegation
ISO/TC215 WG1

Scope

To prepare a report with Security WG4 on ownership and access considerations for the proposed ISO Healthcare Record Standard. The purpose of this report is to identify some implementable solutions in the management of healthcare record ownership, access, and security. Ownership issues can be deconstructed into four interdependent concepts: rights, obligations, privacy and access. Rather than being considered peripheral to the 'modelling' process, these concepts and their interrelationship should together be considered intrinsic to the design of the ISO Electronic Healthcare Record Standard. These issues are to be explored with reference to existing work, and the work of WG4, with a technical report.

Specific Aims include:

To work with WG4 to identify appropriate methodologies to manage ownership, access and security for a global system of healthcare information.
To seek out and review the available international literature on ownership and access, and develop an overview of the concerns expressed.
To explore the implications of different concepts of ownership and access for security mechanisms.
To explore and define such concepts as 'ownership', 'stewardship', 'rights', 'obligations', 'roles', 'permission', 'confidentiality', 'privacy', 'secrecy', and 'access'.
To explore the development of a shared technique for defining these concepts in relation to each other, which transcends linguistic, cultural, and political differences.
To define the conformance criteria required for the secure interoperability of global healthcare records.
To suggest a solution for a global ownership and access mechanism that is freely available to all credentialled healthcare workers and free from commercial control.

The main interests that will benefit from the activity:

All participants in the healthcare process would benefit from the establishment of an effective standard for the trusted management and appropriate sharing of information. Such a standard must include a practical way of sharing records across jurisdictional boundaries, where ownership and access criteria may be differently defined.

Feasibility of the activity

This activity is occurring at a time of rapid development of standards and techniques for interoperability of many forms of electronic commerce. The technology to reach these related goals already exists, and a global consensus and mechanisms are now achievable.

Timeliness of the activity

The ISO standard will facilitate the development of technology for sharing healthcare information. A technique for dealing with ownership and access will be an integral part of the standard.

Urgency of the activity

With increasing globalisation of healthcare, there is an immediate danger of monopoly or takeover of the global healthcare market by commercial concerns. Moreover, full realisation of the potential development of the global healthcare environment is held up by questions of ownership and access control.

Benefits to be gained by implementation, and the loss with delay

Developing and implementing a functioning standard now will safeguard all future developments in this area, and permit future access for ideas and practices as yet unborn. (pro res nata)

Harmonisation of existing regulations

By providing guidelines for conformance, the standard will enable local jurisdictions to fine tune their own implementations and format them to be compliant with the global system.