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Tuesday, June 9, 2015

The role of a patient with respect to their chart

For my ethics class I'm writing a term paper that develops an HL7 model showing the various entities, roles, participations and their relationships associated with health information exchange.  The point of this model is to illustrate the various roles with regard to patient data, in order to facilitate ethical evaluation of "Data Blocking".

In the process, I find that there is no appropriate HL7 Role class that can be used to relate a person to the health chart associated with their care.  The health chart role is scoped by the organization that maintains it, when in fact, I had expected it to be scoped by the patient.  The RIM also allows me to relate the organization to a patient chart via the maintainer role, so I think there's some duplication here. The best that I can do is show that the patient role has indirect authority (a role relationship) over the health chart role. But I need a direct role relationship between the patient and their chart is because roles confer rights and responsibilities. I think for this paper I'll use the patient as the scoper and connect the healthcare organization via the maintenance relationship.

This gap is interesting because it shows the disconnect in thinking about patients and their rights and responsibilities with respect to their chart.

Correcting this gap seems fairly tricky. save that there is little to no use of HLTHCHRT in the HL7 2014 Normative Edition.  It might be worth proposing that this role be deprecated, and that a new role: Patient Chart be added, where the player is the Health Chart entity, and the scoper is the Patient.

I'll have to think about that.  RIM Harmonization is a pretty challenging process, and I've already got a lot of irons on the fire (or is that FHIR?).

   Keith





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