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If rules were trees

If rules were trees. SCIMP Conference 6 th Nov 2007 Dr Brian Robson Clinical Director for eHealth NHS NSS. Not Sir Graeme Catto. I don’t know much about trees. “ …a romp through issues of consent, confidentiality and security..”. I hope to persuade you that. Rules are important

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If rules were trees

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  1. If rules were trees SCIMP Conference 6th Nov 2007 Dr Brian Robson Clinical Director for eHealth NHS NSS

  2. Not Sir Graeme Catto I don’t know much about trees

  3. “ …a romp through issues of consent, confidentiality and security..”

  4. I hope to persuade you that.. • Rules are important • We need to be more aware of them • We may not need more • We need to do things differently in future

  5. We will touch on…. Picture of pizza Pic of tree

  6. Channing Crowder on London I didn’t know they spoke English in London…… I couldn’t find London on a map - I know Italy looks like a boot, I learned that…. I know Redskin’s linebacker London Fletcher…that’s the closest thing I know to London. He’s black, so I’m sure he’s not from London…I’m sure that’s a coincidental name !

  7. “If rules were trees” ….if every tree in England cut down, and the Devil himself were to chase you, where would you hide. Sir Thomas More From ‘A Man for All Seasons’

  8. Be careful if we remove our rules..

  9. The information age Information governance must not be a barrier to providing good care The issue of security is of major importance Paul Gray SGHD 6th Nov 2007

  10. The context …..2007

  11. Computers really can improve your health, or at least make your doctor less likely to kill you. The Guardian Jan 2006

  12. Reason to be concerned ?…….piecing our activities together !

  13. A day in the life of … • 08:00 CATV: Channel change from News-24 to Radio-4 • 09:15 BP: Fuel for car at Milnefield, Dundee ? • 09:45 NCP: Car entered NCP Edinburgh 4 • 12:40 WAT: Waterstones Edinburgh, purchased copy of Harry P. • 13:10 NCP: Car exited NCP Edinburgh 4 • 14:20 ANPR: Police camera Perth-2, car doing75mph • 16:00 TESCO: Tesco Dundee-1, groceries • 16:10 CATV: Channel change from Radio-4 to News-24 Courtesy of Dr Mark McGilchrist

  14. A day in the life of … • 08:00 CATV: Channel change from News-24 to Radio-4 • 09:15 BP Petrol: Fuel for car at Milnefield, Dundee • 09:45 NCP: Car entered NCP Edinbugh 4 • 12:40 WAT: Waterstones Edinburgh, purchased copy of Harry P. • 13:10 NCP: Car exited NCP Edinburgh 4 • 14:20 ANPR: Police camera Perth-2; car doing75mph • 16:00 TESCO: Tesco Dundee-1, groceries • 16:10 CATV: Channel change from Radio-4 to News-24 Courtesy of Dr Mark McGilchrist

  15. Reason to be concerned ? …….try ordering a pizza in 2010 ! ..\Desktop\screen.swf Courtesy of Stewart MacDonald

  16. A Cause for Concern? • The UK's largest NHS trust has discovered endemic sharing of passwords and log-in identifications by staff, recording 70,000 cases of "inappropriate access" to systems, including medical records, in one month. • Abortion Act forms containing identifiable information delivered in a torn-open single envelope

  17. The existing rules……..some of our trees.

  18. Does it Matter? • The future health of the population depends on access to these data by healthcare professionals • Workable solutions are required • Patients and staff have the right to expect that information about them will be treated as confidential

  19. Legal and ethical framework • Common Law • Data Protection Act 1998 • Human Rights Act 1998 • Professional Guidance-GMC, NMC… • Contracts of employment

  20. Loads of rules…. • Common Law • Data Protection Act 1998 • Human Rights Act 1998 • Professional Guidance-GMC,NMC,others • Contracts of employment

  21. What we need to know • Data protection principles • Caldicott Principles • Confidentiality Rules

  22. Data protection principles • processed fairly and lawfully • specified and lawful purposes • adequate, relevant and not excessive • accurate and up to date • not be kept for longer than is necessary • processed in accordance with the rights of the subject • safeguard the data • not be transferred outwith the EC unless…

  23. Caldicott Principles • Justify the purpose • Don't use patient-identifiable information unlessabsolutely necessary • Use the minimum necessary patient-identifiable information • Access to patient-identifiable information should be on a strict need-to-know basis • Everyone with access should be aware of their responsibilities • Understand and comply with the law

  24. Don’ts • Don't use personal-identifiable information unless necessary and even then keep minimum. • Send PID on e mail. • Send PID on insecure faxes. • Discuss PID outside work. • Carry PID around unless necessary. • Save PID to hard discs. • Keep PID on PDA’s. • Dispose of PID insecurely.

  25. Clinicians should share data- Professional guidance re sharing of information - 2007 “… Sharing information with other healthcare professionals is important for safe and effective patient care…”

  26. Clinicians should share data - Public opinion re sharing of information - 2005 People do not know very much about how their personal information is stored and shared… Patients support the increasing use of computers… Concerns about security and confidentiality.. “If she was rendered unconscious, who’s going to tell the doctor what she’s on ? Not me. She’s got 10 or 12 different medicines and there’s lots of stuff she can’t take” ……patients recognise the value of sharing information using information technology.

  27. GMC • 'Seeking Patients' Consent: the ethical considerations', 1998. • Good medical practice – due 2008 • Drivers – • Changes in public perception • Changes in working practice • Technology enabled • Put yourself in position to make best decision

  28. New guidance • Must meet principles • Must be practical • Developing a partnership approach with patients • Consent is not a signature on a piece of paper !

  29. More trees…or a third way ? • Engage with public • Engage with staff • Involve patients • (re)gain their trust

  30. New approaches - ECS • ‘mixed’ consent model • Implied consent • Option to opt out • Explicit consent at point of access

  31. New approaches • Supportive • Collaborative • Staff training • Processes and procedures

  32. eHealth Governance • Review of consent and confidentiality ( Spring 2008)

  33. Not sorted …. Not even in England….

  34. ..in the end.. • Thomas More  beheaded • Cromwell  beheaded • Archbishop Cranmer  beheaded • King died of syphillis !

  35. Do we need rules ?

  36. I hope to persuade you that.. • Rules are important • We need to be more aware of them • We may not need more • We need to do things differently in future

  37. thank you

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