Stream: implementers
Topic: patient consent and 'break the glass Qs
Lital Inghel (Dec 07 2021 at 11:50):
is 'break the glass' functionality is some how supported or even required by FHIR?
and another Q-how is patient consent treated in FHIR if at all?
René Spronk (Dec 07 2021 at 12:27):
Supported, yes, required, no. Security guidance can be found at http://build.fhir.org/security.html
John Moehrke (Dec 07 2021 at 13:07):
Break-Glass is an operational thing. FHIR is a Interop and Data-Model thing. They are on different layers of a Systems-Design. As Rene points out, there are some mentions of Break-Glass around Consent resource and on the Security pages. These are discussion around the intersection of the concept. We expect that some Consents will need to record that the patient has allowed or disallowed break-glass. We expect that a RESTful API might need a way to convey that the user has invoked their authorized break-glass privilage.
Derek Ritz (Dec 07 2021 at 19:16):
I've not come across situations where patients consent to BTG. This has been, where I've seen it implemented, a jurisdictional / HIE permitted option... not a patient permitted option. The pattern I'm most familiar with is that a provider queries... is returned some or no data, but it is indicated that data was omitted due to a consent directive... and if it is supported, the provider then invokes a BTG query which returns everything but which lays down a mandatory audit record including the provider's "override" justification.
John Moehrke (Dec 07 2021 at 21:05):
Understood. And I agree. The cases I have seen are where a patient refuses consent, but the overall policy includes a 'patient and clinician safety' override (break-glass). Where the patient is NOT allowed to deny break-glass. BUT there was also countries that came forward with a setting where the patient was allowed to deny and deny break-glass. So we modeled that in the Consent resource.
John Moehrke (Dec 07 2021 at 21:07):
I will note that the country in question, eventually backed down to the clinicians, and removed the regulated policy that would have allowed the patient to deny break-glass.
John Moehrke (Dec 07 2021 at 21:08):
There are still cases where the patient would consent allowing most uses, but where there is a clause that "Dr. Bob" shall never be given my data, not even if my life is in danger.
Vassil Peytchev (Dec 07 2021 at 23:13):
I think the original post contained two separate questions, but the masterful weaving together of the two concepts is still mesmerizing :grinning_face_with_smiling_eyes:
Lital Inghel (Dec 09 2021 at 07:12):
Vassil Peytchev said:
I think the original post contained two separate questions, but the masterful weaving together of the two concepts is still mesmerizing :grinning_face_with_smiling_eyes:
yes, these were 2 not related Q
Last updated: Apr 12 2022 at 19:14 UTC
