Trustworthy Healthcare Ecosystem

Full Title

Examine the healthcare ecosystem from the perspective of a patient of that system.

Context

• The wiki page Health Care Profile establishes the context for this page.
• For a healthcare trust ecosystem to have value for a patient, these criteria are important:

1. The patient can know that their medical and other records are safe within the provider's Electronic Health Record (EHR) database.
2. The user can determine the trustworthiness of other providers that are seeking access to their medical and other records.
3. what a doctor sees a patient for the first time with a chief complaint, there is no trust. The patient provides subjective information about his/her complaint and then the doctor does an objective (clinical ) exam which may or may not validate the initial complaint.. that is the start of a relational trust. If she/he has been a patient for a year + they become an established patient for coding purposes but I would not classify them as a trusted patient in being compliant in following through with a care plan that address their complain.

• TEFCA says that if the patient has a trusted identity the patient should be able to view that episode of medical care, as reflected in their medical record, online and be able to download it and and share it with others .... the latter is a trust as to who the person/patient says they are and is not the relational trust between a physician and patient.

Problems

• If PCP is the source of IAL authentication credentials, can we provide the standards that would relieve them of liability for misuse?

Solutions

Relational Trust

The definition of (relational) trust is to believe in the honesty and reliability of someone or an entity you have known over time, made a good faith effort to live up to an agreement to fulfill their commitment, be it a contract or handshake agreement. ‘Trust’ is a transnational catalyst, the chemistry that initiates an interaction and reaction if not abused.

Online Trust

• Create standards that would leverage the IAL2 authentication with the PCP to build IAL2 authentication with other medical providers.
• In a digital economy, where online transactions are spontaneous, there is no trust in knowing who a user or entity is, so a measurable level of confidence must be determined instantly. This is a must if parties are to perform as expected in a digital exchange; an implied contractual agreement. This digital trust process underpins every digital interaction by evaluating a user’s digital identity attributes, with expectations of who that user or entity claims to be and if they will behave in an expected manner that represents their trustworthiness

Patient Consent

• Create a consent receipt for moving medical records from one provider to another provider.
• When medical records come from the patient that consent would also be captured and given to the new provider.
• How to capture the patient consent in digital format and transfer that to another provider.

Federated Trust

• In a federated system there will be at least one trust anchor that provide trust certificates to the members of the federation.

Record Matching

No patient is fully trusted when approaching the receptionist or any health care provider beyond the personal physician. The essential problem is that mistakes happen in health care and the wrong records get attached to the wrong human being. This can cause disastrous consequences. Ensuring that the provider that is immediately attending to the patient have relevant information about the patient is essential to good outcomes.

References

• The wiki page Health Care Profile establishes the context for this page.