[Openid-specs-heart] Patient Consent

[Salyards, Kenneth (SAMHSA/OPPI)]

Hi John, sorry if I quoted you wrongly. The bottom line is if you are tagging something or redacting something you still have to have something that can facilitate that process; i.e., a segmentation engine or a tagging engine. Without this capability, tagging or segmenting cannot work. Ken

From: John Moehrke [mailto:johnmoehrke at gmail.com]
Sent: Tuesday, July 12, 2016 3:55 PM
To: Salyards, Kenneth (SAMHSA/OPPI)
Cc: Debbie Bucci; openid-specs-heart at lists.openid.net
Subject: Re: [Openid-specs-heart] Patient Consent

Ken,

I didn't say that... I said that the FHIR 'resources'  structure is not appropriate as a segmentation boundary. That is, in normal REST models one puts sensitive data into different kind of Resources. Where in FHIR resources contain a wide mixture of sensitive data.

The mechanism that is built into FHIR to enable privacy/security segmentation is the securityLabel. One can absolutely use this meta tag system to segment data. This is indeed what I am recommending through the suggestion that we use the _confidentiality valueset.

John

John Moehrke
Principal Engineering Architect: Standards - Interoperability, Privacy, and Security
CyberPrivacy – Enabling authorized communications while respecting Privacy
M +1 920-564-2067
JohnMoehrke at gmail.com<mailto:JohnMoehrke at gmail.com>
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https://healthcaresecprivacy.blogspot.com
"Quis custodiet ipsos custodes?" ("Who watches the watchers?")

On Tue, Jul 12, 2016 at 2:12 PM, Salyards, Kenneth (SAMHSA/OPPI) <Kenneth.Salyards at samhsa.hhs.gov<mailto:Kenneth.Salyards at samhsa.hhs.gov>> wrote:
Hello Debbie, here is a high-level view of the Consent 2 Share (C2S) architecture. For the RS to be able to do what you are proposing, it would need to have a segmentation engine to enforce fined grain consent directives. Enforcing these consent directives is based on (for C2S at least) value sets based on diagnosis, medications, tests/labs and procedures associated with the sensitive conditions. We have defined these types of value sets which are used in C2S for data segmentation. I can send them to you if you would like to see the content. Also, segmentation can only be accomplished currently on structured clinical content. We are exploring ways in which to use the value set content to redact textual information related to sensitive conditions, however currently we redact all text in a segmented document.

With the current state-of-art in EHR technology, the content of exchanged records is highly variable from simple text documents (all CDA really requires) to documents with text and actual clinical entries. In the future FHIR may improve this pitiful condition.

As John has said before, there is no inherent capability within FHIR that can define a resource set that provides data segmentation at any level.

Hope this helps, Ken.

From: Openid-specs-heart [mailto:openid-specs-heart-bounces at lists.openid.net<mailto:openid-specs-heart-bounces at lists.openid.net>] On Behalf Of Debbie Bucci
Sent: Monday, July 11, 2016 3:31 PM
To: John Moehrke
Cc: openid-specs-heart at lists.openid.net<mailto:openid-specs-heart at lists.openid.net>
Subject: Re: [Openid-specs-heart] Patient Consent

So ... the RS  *should* have an idea of what medications aligns with  each diagnosis.   Wouldn't a patient request to not reveal /release HIV for some purpose of use info be enough info to provide to the RS to use (but note the RS may not comply due to various reasons  - but should record for audit purposes)

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