title: Access to EHR and access control at a moment in the past: a discussion of the need and an exploration of the consequences.
abstract: The Electronic Health Record (EHR) will become a major support tool in health care delivery. This leads to heavy requirements for its quality and security. The EHR not only has to present the medical data of the patient as they are at the present time, we can anticipate that in situations of medical audit, law suits, quality control and self-assessment it may be necessary to be able to replay the EHR output as it was or would have been at a certain moment in the past. This facility could be required in order to be able to judge whether the behaviour of the health care practitioner was adequate in view of the information in the EHR as it was presented or could have been obtained from the EHR. First the need for such facility is discussed. Next the question is posed how sufficient interest for this aspect of the EHR can be raised and what role IMIA might play here. The technical consequences of the implementation of such facility are explored and they are found to be huge. The conclusion is that for a successful implementation of an EHR that (at least partly) replaces the paper record the facility is a must. However, in order to implement it, significant investments have to be made especially in development and adaptation of software. If we do not take action now the facility will not be available in time and the lack of such facility will become a road-block for EHR implementation.
authors.affiliation: Addabit B V, Atjehweg 10, 2202AP Noordwijk, The Netherlands. abakker@addabit.demon.nl
authors.forename: Ab
authors.initials: A
authors.lastname: Bakker
mesh_terms: D022126:Access to Information; D016494:Computer Security; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration / Q000592:standards*; D012637:Security Measures