Demographics service

[lakewood]

Hi Kerry,

Historical documents under the American version of English Common Law are admissible
after 30 years, and before in some jurisdictions by affidavit from a Custodian. This can change
at any time. A potential solution, presuming Custodial Affidavit, is entering the record in a
Custodial Record that retains originals. This will provide a Custodial Trail for the records.

Check this out with an appropriate Attorney in practice in your Jurisdiction.

Entering a historical document within an EHR poses a different problem. Presuming a secure
EHR system, the document must be properly authenticated/certified prior to entry and a
Custodial Trail maintained until used. It must be admissible prior to entry into the EHR.

This varies by Jurisdiction and one should check this out with an appropriate attorney.

A caveat would be: Avoid changing Jurisdictions. Assuming that a historical document in
one Jurisdiction would be admissible in another Jurisdiction is tricky. Back to the
appropriate Attorney!

Migrating a Historical Document to an EHR is a good idea for at least the following reasons:
1)Electronic records are admissible in many Jurisdictions
2)Secure Healthcare Electronic Records can be handled as other Electronic Records
(e.g., bank records), e.g., custom in the industry.

Again one needs the appropriate Attorney to ensure that Healthcare Electronic Records
are treated as other Electronic Records.

In your Jurisdiction there may be prior rulings on the admissible of Healthcare records,
or similar records. It may be useful to access the rulings to determine prior case law.

Unfortunately, Legislative Enactment and prior case law will likely vary somewhat among
Jurisdictions within a country; they do between countries especially where to source of
law differs, e.g., English Common Law. I usually refer to prior case law on Electronic
Records used in Banking (center-weight!).

Technology and relevant law evolve with time. Expect and anticipate change.

Regards!

Thomas Clark

Kerry Raymond wrote:

[lakewood]

Hi Sam,

Is the indicated sentence correct?

Regards!

-Thomas Clark

Sam Heard wrote:

Dear All

The openEHR design team have, over many years, decided to separate the demographic information from the EHR data. Advantages are, amongst others:
1. Security - you need access to both sets of data to know about an individual
2. Normalisation - you can find people even though they have moved, changed their name etc
3. Many health environments have developed demographic services which people want to keep.

The EHR model has quite different classes than the EHR model - and the archetypes are therefore different.

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

'EHR model' <-------------------> 'EHR model'

[lakewood]

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 transmission, but then to Requestor's and Receiver's digital
signatures can be used (again short lifetime). While actively being handled/processed
an audit trail is handy.

A Historical Electronic Record in a Court of Law is required to emulate that of say a
paper Historical Record. If the law states 30 years, then make it 30 or change the law.

This is probably not feasible since changing this law that has existed for some time may
have to satisfy other requirements that lead to its enactment.

-Regards!

-Thomas Clark

Sebastian Garde wrote:

[USM_Bish1 (USM Bish)]

lakewood@copper.net wrote:

Hi Sam,

Is the indicated sentence correct?

Regards!

-Thomas Clark

The EHR model has quite different classes than the EHR model - and the archetypes are therefore different.

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

'EHR model' <-------------------> 'EHR model'

Looks like a 'slip of the tongue' ... probably what is inferred is
the demographic classes vis-a-vis the EHR classes.

Just my interpretation

Bish

[Gavin_Brelstaff]

Kerry Raymond wrote:

There are undeniably enormous challenges in this area.

However, right now, we have a health system that operates off bits of paper augmented with IT here and there. Can we verify the authenticity of a medical record from the 1970s today? Will a paper health record created today be authenticated in 2030? If a doctor receives a medical history on paper and one of the pages has a fold on the corner which causes two pages to be turned instead of one, can we prove in a court today if the doctor did or didn't see the information on the second page? Hey, forensic science isn't that good even on CSI

Surely the goal of EHR is to do better than the existing systems in some areas (so there is benefit in choosing EHR), and no worse in others (so there is no significant detriment)? For example, won't some patients have better outcomes because their doctors have access to their past allergic reactions thanks to an EHR, even if we cannot prove in a court whether the information did or didn't get rendered correctly on a computer screen?

If we are serious about proving in court "what the doctor saw", I can only suggest that we create a head-mounted device with a camera (positioned at eye level) and microphones positioned at ears and mouth and record every second of the doctor's working life as evidence of what they saw, heard and said.

The point here is not a big-brother forensic approach
- but rather one in which the medic cannot deny that they had the opportunity to consult the entire record document
[electronic or paper] that arrived on their [virtual or real]
desktop - in the state of completeness that it happened to arrive.

In that case the medic can carry our their traditional *responsibility*
extracting all the relevant details available in that record document
- unmonitored. [Of course they might like to call a colleague to check
the facts - as they traditionally have done and surely will want to go
on doing]

The system designer's *responsibiity* is to not make that
opportunity more difficult in the case of an electronic document than it
is in the case of a paper record.

\Gavin

[USM_Bish1 (USM Bish)]

The longitivity/ validity of a digital signature, specially if
distributed would obviously need the requisite revoke cycle.

My concept of the 'notary server' is more of a 'backup server'
and only to be referenced on a need basis. It is more of a
process of data in, in, in and more data in ... with sporadic
data reads only by very selective authorities (in official
capacity). The keys of the signitory may change with change of
office. Since these keys are not for circulation, and for
consumption only by few selected people entrusted with the
'notary server' there should not be a problem in holding on to
such 'exclusive' key archives (specific for the notary) for
ages to come without change. As longs as physical security of
the 'keys' are ensured, there should not be much of a
requirement of rotation, since each notary signitory is
specific for a time and place.

Your views on issues of cryptographic algorithm weaknesses are
absolutely valid if the keys are to be distributed beyond the
confines of the notary server, or 'trusted' agencies ...

Data exchanges should be from the regular servers and not from
the notary servers, for day to day transactions, and not all
transactions would need notary archival.

Just my POV ...

Bish

[lakewood]

Hi Kerry,

A Court case in the US involving testimony by a Healthcare Practitioner, whether a
party or an Expert Witness', the 'admissible evidence' includes notes, orders, Patient
History and other record-oriented evidence. Testimony is in part directed at this
'admissible evidence' but also includes Professional Opinion.

A "... a head-mounted device with a camera ... and microphones ..." would add additional
information to the body of 'admissible evidence'. A possible concern is the impact upon
Court proceedings this additional 'admissible evidence' would have.

Before launching an effort to accomplish integration of these additional sensors one might
consult appropriate Attorneys and attempt to determine if in fact an improvement is
possible.

My suggestion is that based upon reported experiments with Courts (includes Juries) and
groups of people, all participants viewing the same sequence of events, interpretations
often widely.

Unambiguous interpretations is a goal. Integrating information within an EHR that
supports ambiguous interpretations should be avoided where possible.

Regards!

-Thomas Clark

Kerry Raymond wrote:

[Karsten_Hilbert]

However, right now, we have a health system that operates off bits of
paper augmented with IT here and there.

...

Surely the goal of EHR is to do better than the existing systems in some
areas (so there is benefit in choosing EHR), and no worse in others (so
there is no significant detriment)?

Well spoken. This practical sentiment is exactly why I pointed
out where it leads to worry too much about having perfect
security instead of focussing on patient and provider benefit.

If we are serious about proving in court "what the doctor saw", I can
only suggest that we create a head-mounted device with a camera
(positioned at eye level) and microphones positioned at ears and mouth
and record every second of the doctor's working life as evidence of what
they saw, heard and said.

And this is what it would lead to.

Karsten

[Sam (Sam Heard)]

No - sorry - It should read "The Demographic model has quite..."
Sam