Semantic Web-Based Information Systems: State-of-the-Art ...
Semantic Web-Based Information Systems: State-of-the-Art ...
Semantic Web-Based Information Systems: State-of-the-Art ...
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Distributed Patient Identification Protocol 249<br />
takes place during <strong>the</strong> second phase <strong>of</strong> <strong>the</strong> protocol when <strong>the</strong> requestor uses <strong>the</strong><br />
modified Retrieve <strong>Information</strong> for Display protocol to request and access clinical<br />
documents for a specific patient. Correspondingly, <strong>the</strong>re are two places at which<br />
additional barriers can be installed in <strong>the</strong> protocol, barriers that will be opened<br />
automatically or manually once <strong>the</strong> patient consent has been demonstrated to <strong>the</strong><br />
record repository:<br />
• The requestor may deposit a pro<strong>of</strong> <strong>of</strong> <strong>the</strong> patient consent at <strong>the</strong> RLS when initiating<br />
<strong>the</strong> query. The RLS would make this document available only to those<br />
record repositories that have been identified as matches in <strong>the</strong> record linkage<br />
and request permission to report <strong>the</strong>m back to <strong>the</strong> requestor. Only repositories<br />
granting this permission would ever be reported to <strong>the</strong> requestor.<br />
• The RID access to clinical documents for a specific candidate may require additional<br />
authorisation at <strong>the</strong> repository site requiring a prior communication <strong>of</strong><br />
<strong>the</strong> pro<strong>of</strong> <strong>of</strong> patient consent. It also would be possible to restrict access within<br />
<strong>the</strong> RID protocol to specific documents or document types (e.g., radiology<br />
reports).<br />
Two different approaches for demonstrating patient consent are conceivable — <strong>the</strong><br />
use <strong>of</strong> a public key infrastructure (PKI) for patients or a conventional out-<strong>of</strong>-band<br />
communication using possibly digitised letters, telephone, mail, or fax conversation.<br />
A PKI for patients would allow for a solution <strong>of</strong> <strong>the</strong> issue <strong>of</strong> patient consent in a<br />
fully digital manner by providing a digital signature <strong>of</strong> <strong>the</strong> patient authorising <strong>the</strong><br />
request. This, however, would require that certificates and security tokens for <strong>the</strong><br />
private key, such as smartcards, be issued for all patients. While a few countries,<br />
including Belgium, Taiwan, and Germany, have plans for a PKI for <strong>the</strong> health care<br />
sector (Dietzel & Riepe, 2004), <strong>the</strong>re are no such plans in many o<strong>the</strong>r countries, and<br />
<strong>the</strong>re is no sign <strong>of</strong> a global or at least a European-wide harmonisation <strong>of</strong> <strong>the</strong>se PKIs<br />
(<strong>the</strong> European health insurance card does not include PKI functionality).<br />
Since a PKI-based solution will not be available in <strong>the</strong> foreseeable future for<br />
cross-border communication, a conventional approach needs to be supported. As<br />
an example, <strong>the</strong> patient may be asked to sign a letter <strong>of</strong> consent at <strong>the</strong> requesting<br />
health care institute, and a digitised copy <strong>of</strong> this letter could be deposited with <strong>the</strong><br />
RLS and made available to <strong>the</strong> record repositories for which matches were found<br />
during <strong>the</strong> record linkage process. The data protection <strong>of</strong>ficer at each health care<br />
institute operating a record repository would check <strong>the</strong> letter <strong>of</strong> consent and, if appropriate,<br />
give permission to <strong>the</strong> RLS to report <strong>the</strong> location <strong>of</strong> <strong>the</strong> record repository<br />
back to <strong>the</strong> requestor and grant access to certain clinical documents. In cases where<br />
an original handwritten signature is legally required, <strong>the</strong> digitised document could<br />
be accompanied by a contact address at <strong>the</strong> requesting health care institute where<br />
a delivery <strong>of</strong> an original document (e.g., by express service) could be requested.<br />
While it is not realistic to assume a working PKI for patients as a prerequisite to<br />
a digital cross-border exchange <strong>of</strong> clinical records, a working PKI for <strong>the</strong> health<br />
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