Security of health care records in Belgium. Application in a University Hospital.

Access rules to electronic patient records (EPR) have been issued by the Belgian Council of Physicians. Access to identifiable data of the EPR is restricted to anyone responsible for diagnosis, treatment and continuity of care of the patient. By delegation, associated personnel, like secretaries, can also be authorised to have access. A new perspective is given by the availability in 2003 of a national identification card allowing electronic signature of patients. It could not only authorise but also forbid some accesses. A law in 2002 gives right to patients to access to their own record. Health personnel can also be identified by cards but the system is not yet implemented. In the meantime, local measures have been made. We describe practical solutions that have been taken as priorities in a University Hospital. It was felt more important to allow access to lifesaving EPR data than to restrict its access by too strictly theoretical rules. A pilot study (S3 project) is also in progress for interinstitutional communication in Belgium, using the unique identification number of the patient and a "third server"

Le Résumé du dossier médical : indicateur informatisé de performance et de qualité de soins / Francis H. Roger

Thèse d'agrégation de l'enseignement supérieur (Faculté de médecine) -- UCL, 198

Ethics and biomedical information.

Ethical rules are similar for physicians in most countries that follow the Hippocratic oath. They have no formal legal force, but can be used as a reference to provide answers to solve individual cases. It appears erroneous to believe that privacy is about information. It is about relationship. In medicine, there is a contract between a patient and a physician, where health care personnel has to respect secrecy, while integrity and availability of information should be obtained for continuity of care. These somewhat contradictory objectives have to be applied very carefully to computerised biomedical information. Ethical principles have to be made clear to everyone, and society should take the necessary steps to organise their enforcement. Several examples are given in the delivery of health care, telediagnosis, patient follow-up. clinical research as well as possible breakthroughs that could jeopardise privacy, using biomedical information

Purposes of health identification cards in belgium.

Although other alternatives might exist, identification cards have been chosen as an acceptable and adequate tool to be used to identify patients and health professionals.They are planned for a digital signature and for access to electronic health records as well as for health information exchange and for databases querying. Local applications might exist independently, but the Federal State has now developed BeHealth, a platform for health professionals, social security personnel as well as the great public to facilitate a common access to some health data. Security conditions have been defined and are described

Purposes of health identification cards and role of a secure access platform (Be-Health) in Belgium

Although other alternatives may exist, identification cards have been chosen as an acceptable and adequate tool to be used to identify patients and health professionals. It is planned to use these for digital signature and for access to electronic health records: for searching various databases as well as for health information exchange. Local applications might exist independently, but the Belgian federal state has now developed Be-Health, a platform for health professionals, social security personnel and the general public, designed to facilitate a secure common uniform access to certain health data. (c) 2006 Elsevier Ireland Ltd. All rights reserved

The ALFA (Activity Log Files Aggregation) Toolkit: A Method for Precise Observation of the Consultation

Background: There is a lack of tools to evaluate and compare Electronic patient record (EPR) systems to inform a rational choice or development agenda. Objective: To develop a tool kit to measure the impact of different EPR system features on the consultation. Methods: We first developed a specification to overcome the limitations of existing methods. We divided this into work packages: (1) developing a method to display multichannel video of the consultation; (2) code and measure activities, including computer use and verbal interactions; (3) automate the capture of nonverbal interactions; (4) aggregate multiple observations into a single navigable output; and (5) produce an output interpretable by software developers. We piloted this method by filming live consultations (n = 22) by 4 general practitioners (GPs) using different EPR systems. We compared the time taken and variations during coded data entry, prescribing, and blood pressure (BP) recording. We used nonparametric tests to make statistical comparisons. We contrasted methods of BP recording using Unified Modeling Language (UML) sequence diagrams. Results: We found that 4 channels of video were optimal. We identified an existing application for manual coding of video output. We developed in-house tools for capturing use of keyboard and mouse and to time stamp speech. The transcript is then typed within this time stamp. Although we managed to capture body language using pattern recognition software, we were unable to use this data quantitatively. We loaded these observational outputs into our aggregation tool, which allows simultaneous navigation and viewing of multiple files. This also creates a single exportable file in XML format, which we used to develop UML sequence diagrams. In our pilot, the GP using the EMIS LV (Egton Medical Information Systems Limited, Leeds, UK) system took the longest time to code data (mean 11.5 s, 95% CI 8.7-14.2). Nonparametric comparison of EMIS LV with the other systems showed a significant difference, with EMIS PCS (Egton Medical Information Systems Limited, Leeds, UK) (P = .007), iSoft Synergy (iSOFT, Banbury, UK) (P = .014), and INPS Vision (INPS, London, UK) (P = .006) facilitating faster coding. In contrast, prescribing was fastest with EMIS LV (mean 23.7 s, 95% CI 20.5-26.8), but nonparametric comparison showed no statistically significant difference. UML sequence diagrams showed that the simplest BP recording interface was not the easiest to use, as users spent longer navigating or looking up previous blood pressures separately. Complex interfaces with free-text boxes left clinicians unsure of what to add. Conclusions: The ALFA method allows the precise observation of the clinical consultation. It enables rigorous comparison of core elements of EPR systems. Pilot data suggests its capacity to demonstrate differences between systems. Its outputs could provide the evidence base for making more objective choices between systems. Keywords: Video recordings, process assessment, observation, attitude to computer, professional-patient relations, general practice, family practice, decision modeling, process assessment, medical informatics, computers, medical records systems, computerized, electronic patient record (EPR), electronic medical record (EMR), evaluation methodologies, usabilit

História como alegoria

Neste artigo abordam-se as diferentes circunstâncias nas quais se tecem comentários sobre um evento (geralmente no passado) quando os comentadores estão, na verdade, preocupados com um outro evento (geralmente no presente). Nele, distingue-se a alegoria pragmática - que se encontra onde quer que haja restrições à liberdade de agilidade política - da alegoria mística - que pressupõe algum tipo de conexão oculta entre os dois acontecimentos. Este segundo tipo de alegoria entrou em declínio no fim do século xvii, mas poderá permanecer mais influente do que todos nós pensamos.<br>This article is concerned with the different circunstances in wich comments are made as one event (usually in the past) when the commentators are really preoccupied with another (usually in the present). It distinguishes pragmatic allegory, to be found whenever there are restrictions on freedom of political speed, from mystical allegory, which assumes some kind of occult connection between the two events. This second kind of allegory has been in decline since the end of the seventeenth century, but it may remain more influential on us all than we think