Architecture of a consent management suite and integration into IHE-based regional health information networks

<p>Abstract</p> <p>Background</p> <p>The University Hospital Heidelberg is implementing a Regional Health Information Network (RHIN) in the Rhine-Neckar-Region in order to establish a shared-care environment, which is based on established Health IT standards and in particular Integrating the Healthcare Enterprise (IHE). Similar to all other Electronic Health Record (EHR) and Personal Health Record (PHR) approaches the chosen Personal Electronic Health Record (PEHR) architecture relies on the patient's consent in order to share documents and medical data with other care delivery organizations, with the additional requirement that the German legislation explicitly demands a patients' opt-in and does not allow opt-out solutions. This creates two issues: firstly the current IHE consent profile does not address this approach properly and secondly none of the employed intra- and inter-institutional information systems, like almost all systems on the market, offers consent management solutions at all. Hence, the objective of our work is to develop and introduce an extensible architecture for creating, managing and querying patient consents in an IHE-based environment.</p> <p>Methods</p> <p>Based on the features offered by the IHE profile Basic Patient Privacy Consent (BPPC) and literature, the functionalities and components to meet the requirements of a centralized opt-in consent management solution compliant with German legislation have been analyzed. Two services have been developed and integrated into the Heidelberg PEHR.</p> <p>Results</p> <p>The standard-based Consent Management Suite consists of two services. The Consent Management Service is able to receive and store consent documents. It can receive queries concerning a dedicated patient consent, process it and return an answer. It represents a centralized policy enforcement point. The Consent Creator Service allows patients to create their consents electronically. Interfaces to a Master Patient Index (MPI) and a provider index allow to dynamically generate XACML-based policies which are stored in a CDA document to be transferred to the first service. Three workflows have to be considered to integrate the suite into the PEHR: recording the consent, publishing documents and viewing documents.</p> <p>Conclusions</p> <p>Our approach solves the consent issue when using IHE profiles for regional health information networks. It is highly interoperable due to the use of international standards and can hence be used in any other region to leverage consent issues and substantially promote the use of IHE for regional health information networks in general.</p

Sami-speaking municipalities and control group's access to somatic specialist health care (SHC): a retrospective study on general practitioners' referrals

Artikkel som omhandler henvisning til spesialisthelsetjeneste i samiskspråklige kommuner og kontrollgruppe.Objectives: the Sami people constitute the indigenous people in northern Norway. The objective of this study was to clarify whether they have a similar supply of somatic specialist health care (SHC) as others. Methods: the referrals from general practitioners (GPs) in the primary health care (PHC) in the administration area of the Sami language law (8 municipalities) were matched with a control group of 11 municipalities. Population data was accessed from Statistics Norway and the time period 2007–2010 was analysed. The main outcome was the number of referrals per 1,000 inhabitants according to age group, gender and place of living. Results: 504,292 referrals in northern Norway were indentified and the Sami and control group constituted 23,093 and 22,541 referrals, respectively. The major findings were a similar referral ratio (RR) (1.14 and 1.17) (p =0.624) and women more commonly referred (female/male ratio 1.45 and 1.41) in both groups. GPs in both groups were loyal to their local hospital trust. Conclusion: inhabitants in Sami-speaking municipalities in northern Norway have a similar supply of SHC services as controls. Inter-municipal variation was significant in both groups