<html><body style="word-wrap: break-word; -webkit-nbsp-mode: space; -webkit-line-break: after-white-space; "><br><div><br></div><div><div><div>On 26 jul 2009, at 11:23, Ross Anderson wrote:</div><br class="Apple-interchange-newline"><blockquote type="cite"><span class="Apple-style-span" style="border-collapse: separate; color: rgb(0, 0, 0); font-family: Helvetica; font-size: medium; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-border-horizontal-spacing: 0px; -webkit-border-vertical-spacing: 0px; -webkit-text-decorations-in-effect: none; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">The techie would be far better trained, and have a far better<br>understanding of "file locking, version control, access and<br>write levels / permissions". The gynaecologist didn't have<span class="Apple-converted-space"> </span><br>such training: she had incentives, from a direct duty of care<br>to her patients, through to the survival of her business.<br></span></blockquote><br></div><div>I.E.<div><br></div><div>Always the author (or his successor) of the information supplied, is the prime accountable person.</div><div>Government, techies, Caldicott Angels, SPINE authorities, other secondary involved persons are facilitators of the author, only.</div><div>Never the other way around.</div><div><br></div><div>It is the prime responsible author that is in a position to make an informed judgement wether, and to whom, to divulge information he authored.</div><div>No organisational policy, technical contraption is able to make this informed judgement.</div><div>IT facilitates the author in the role of healthcare provider/documenter/author in order to fulfill its responsibilities towards its patient.</div><div><br></div><div>The role of the patient is to instruct the author how to operationalise the patient given instructions for access control. (The patient mandate, informed consent)</div><div>Leaving room for professional freedom not to follow the patient instruction under extreme conditions such as conflict of . Actions that can be contested in court.</div><div><br></div><div>The principle of (digital) documentation, that under all circumstances the accountable author must make an informed decision before divulging information, will have serious consequences for Patient Summary and other National health IT-projects.</div><div>It means that solely both the patient and healthcare provider/author define the content and the privacy and access control policies.</div><div>Others should never top down enforce patients and healthcare providers//authors into systems that breach this principle.</div><div><br></div><div>With regards,</div><div><br></div><div><br></div><div>Gerard Freriks</div></div><br><div> <span class="Apple-style-span" style="border-collapse: separate; color: rgb(0, 0, 0); font-family: Helvetica; font-size: medium; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-border-horizontal-spacing: 0px; -webkit-border-vertical-spacing: 0px; -webkit-text-decorations-in-effect: none; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="word-wrap: break-word; -webkit-nbsp-mode: space; -webkit-line-break: after-white-space; "><div><span class="Apple-style-span" style="font-size: 12px; ">-- <private> --<div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Gerard Freriks, MD</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Huigsloterdijk 378</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">2158 LR Buitenkaag</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">The Netherlands</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 9px/normal Monaco; min-height: 12px; font-family: Monaco; font-size: 9px; "><br style="font-family: Monaco; font-size: 9px; "></div><div>T: +31 252544896</div><div>M: +31 620347088</div><div>E: <a href="mailto:gfrer@luna.nl">gfrer@luna.nl</a></div><div><br></div></span></div></div></span><br class="Apple-interchange-newline"> </div><br></div></body></html>