1. Medical Use Cases Based on HL7 Clinical Document Architecture (an ANSII standard) based on XML Medical considerations Legislation and Executive Branch rules regarding privacy (HIPAA)

2. HL7 CDA Form Header – administrative information Body – clinical record

3. Ms AXS & her abusive ex Don’t let him know my contact info a) She gets help with tendonitis from a physical therapist Therapist gets record; the restrictions follow b) Billing info goes to outside payer Restrictions are transmitted with info (even when the info leaves the originator, the restrictions persist)

4. Patient grants only primary care physician access to psych notes Primary care physician grants overall record access to a covering doctor or practice, but blocks access to the psych notes.

5. Patient restricts access to HIV test results The patient arrives at the emergency room with a severe trauma. The restrictions are overridden to provide the best treatment.

6. Patient is a care giver in a medical system For the whole record, the patient grants access only to the primary care giver. If billing is done in house, the billing staff is granted access to the record of services and charges.

7. Summary of Requirements ACLs + selectors yielding fine grained access control Persistence of access semantics over organizational boundaries Override mechanism(s) such as “super user” Ability to change access over time and context