1. From Privacy to Information Governance Dr Petra Wilson Internet Business Solutions Group - Cisco

2. Cisco Confidential IBSG - 2 Copyright © 2007 Cisco Systems, Inc. All rights reserved. Historically  One-to-one relationships based on traditional medical privacy  Doctor owned and controlled records  Passive patients

3. Cisco Confidential IBSG - 3 Copyright © 2007 Cisco Systems, Inc. All rights reserved. The Changing face of Healthcare delivery in Europe Patients are no longer registered with individual general practitioners but registered with multi-partner practices or use walk-in centres. GPs are no longer the sole gatekeepers to healthcare. Wider range of healthcare delivered by nurses and pharmacists with extended roles. Increasing numbers of healthcare professionals are seeking to work part- time. More specialist care delivered in co-operation with GPs The rise of the resourceful patient (the decline of the sapienitial authority of the GP). The rise of personal health management and health consumerism. Significant investments in information management in healthcare.

4. Cisco Confidential IBSG - 4 Copyright © 2007 Cisco Systems, Inc. All rights reserved. Information flow in health care - simplified

5. Cisco Confidential IBSG - 5 Copyright © 2007 Cisco Systems, Inc. All rights reserved. The Current Conundrum Doctors have a legal and ethical duty of confidentiality for all identifiable health information learnt in a professional capacity. AND Patients expect doctors to share relevant information appropriately, making it promptly accessible when necessary their care. AND If the expectation of appropriate sharing is not met patients will withhold information to the detriment of their own and other peoples’ care.

6. Cisco Confidential IBSG - 6 Copyright © 2007 Cisco Systems, Inc. All rights reserved. From Privacy to Data Protection Medical Data Processing is prohibited (Art 8 Directive 95/46/EC) unless: Explicit informed consent has been obtained from the data subject (article 8(2)(b)). Or It is in vital interests of the patient or of another person, AND the data subject is physically or legally incapable of giving consent (article 8(2)(c)). Or it is necessary for preventive medicine, medical diagnosis, the provision of care or treatment or the management of health-care services AND the personal data in question are processed by a health professional (article 8(3)). Or if there is a substantial public interest in the processing (article 8(4)).

7. Cisco Confidential IBSG - 7 Copyright © 2007 Cisco Systems, Inc. All rights reserved.  creation of medical records is a necessary and unavoidable consequence of the medical situation  Withholding of consent may be to the patient’s detriment.  All possible future users and purposes cannot be known at time of creation Explicit and Informed consent

8. Cisco Confidential IBSG - 8 Copyright © 2007 Cisco Systems, Inc. All rights reserved.  creation of medical records is a necessary and unavoidable consequence of the medical situation  Withholding of consent may be to the patient’s detriment.  All possible future users and purposes cannot be known at time of creation Explicit and Informed consent for EHR CONSENT ????

9. Cisco Confidential IBSG - 9 Copyright © 2007 Cisco Systems, Inc. All rights reserved.  Requires: life-saving treatment in a context where patient is not able to express him- or herself.  Would require a construction that sees all healthcare in the vital interests of patients Vital Interests

10. Cisco Confidential IBSG - 10 Copyright © 2007 Cisco Systems, Inc. All rights reserved.  Requires: life-saving treatment in a context where patient is not able to express him- or herself.  Would require a construction that sees all healthcare is in the vital interests of patients Vital Interests Vital Interests ?????

11. Cisco Confidential IBSG - 11 Copyright © 2007 Cisco Systems, Inc. All rights reserved.  Must be processed by a healthcare professional  “required” – not merely useful  doubtful if this is adequate justification for collection of all medical data Preventive medicine, medical diagnosis, the provision of care or treatment or the management of health-care services

12. Cisco Confidential IBSG - 12 Copyright © 2007 Cisco Systems, Inc. All rights reserved.  Must be processed by a healthcare professional  “required” – not merely useful  doubtful if this is adequate justification for EHR creation Preventive medicine, medical diagnosis, the provision of care or treatment or the management of health-care services Required for care and treatment ??????

13. Cisco Confidential IBSG - 13 Copyright © 2007 Cisco Systems, Inc. All rights reserved. if there is a substantial public interest in the processing, special rules may be adopted ……. So what would those rules look like? Public Interest

14. Cisco Confidential IBSG - 14 Copyright © 2007 Cisco Systems, Inc. All rights reserved. Data should be:  fairly and lawfully collected processed;  Collected with knowledge and agreement of data subject (implied or explicit)  processed for known /knowable and limited purposes;  accurate, adequate, relevant and not excessive;  not kept for longer than is necessary;  processed in line with data subjects’ rights of access and correction  securely stored and shared From Data Protection to Public Interest Information Governance

15. Cisco Confidential IBSG - 15 Copyright © 2007 Cisco Systems, Inc. All rights reserved.  Consent Implicit consent and opt-out system for general information opt-in for sensitive information (visible) Sealed envelopes Personalised privacy rules ……………………. Public Information Campaigns Public Interest based Medical Information Governance

16. Cisco Confidential IBSG - 16 Copyright © 2007 Cisco Systems, Inc. All rights reserved.  Security and Authenticity Strong authentication techniques electronic signatures Audit Trail Appropriate annonymisation (PETs) ………………. visible correction ?? Public Interest based Information Governance

17. Cisco Confidential IBSG - 17 Copyright © 2007 Cisco Systems, Inc. All rights reserved.  Access Role dependent authorization (inc. patient) Patient defined emergency access Audit trail of all access Public Interest based Information Governance

18. Cisco Confidential IBSG - 18 Copyright © 2007 Cisco Systems, Inc. All rights reserved.  Ownership and Control Patient Named healthcare professional National Health System …….. Liability, replaceability, accuracy Public Interest based Information Governance

19. Cisco Confidential IBSG - 19 Copyright © 2007 Cisco Systems, Inc. All rights reserved. Public Interest based Information Governance ……Creating balance between patient confidentiality and access to patient information by healthcare professionals

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