If rules were trees

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If rules were trees

• SCIMP Conference
• 6th Nov 2007
• Dr Brian Robson
• Clinical Director for eHealth
• NHS NSS

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Not Sir Graeme Catto
I dont know much about trees
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a romp through issues of consent,
confidentiality and security..
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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

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We will touch on.
Picture of pizza
Pic of tree
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Channing Crowder on London

• I didnt know they spoke English in London
• I couldnt find London on a map - I know Italy
  looks like a boot, I learned that.
• I know Redskins linebacker London
  Fletcherthats the closest thing I know to
  London.
• Hes black, so Im sure hes not from LondonIm
  sure thats a coincidental name !

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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

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Be careful if we remove our rules..
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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

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The context ..2007
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(No Transcript)
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(No Transcript)
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• Computers really can improve your health, or at
  least make your doctor less likely to kill you.
• The Guardian Jan 2006

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Reason to be concerned ?.piecing our
activities together !
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A day in the life of

• 0800 CATV Channel change from News-24 to Radio-4

• 0915 BP Fuel for car at Milnefield, Dundee

?

• 0945 NCP Car entered NCP Edinburgh 4

• 1240 WAT Waterstones Edinburgh, purchased copy
  of Harry P.

• 1310 NCP Car exited NCP Edinburgh 4

• 1420 ANPR Police camera Perth-2, car doing75mph

• 1600 TESCO Tesco Dundee-1, groceries

• 1610 CATV Channel change from Radio-4 to News-24

Courtesy of Dr Mark McGilchrist
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A day in the life of

• 0800 CATV Channel change from News-24 to
  Radio-4

• 0915 BP Petrol Fuel for car at Milnefield,
  Dundee

• 0945 NCP Car entered NCP Edinbugh 4

• 1240 WAT Waterstones Edinburgh, purchased copy
  of Harry P.

• 1310 NCP Car exited NCP Edinburgh 4

• 1420 ANPR Police camera Perth-2 car doing75mph

• 1600 TESCO Tesco Dundee-1, groceries

• 1610 CATV Channel change from Radio-4 to News-24

Courtesy of Dr Mark McGilchrist
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Reason to be concerned ? .try ordering a
pizza in 2010 !

• ..\Desktop\screen.swf

Courtesy of Stewart MacDonald
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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

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The existing rules..some of our trees.
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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

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Legal and ethical framework

• Common Law
• Data Protection Act 1998
• Human Rights Act 1998
• Professional Guidance-GMC, NMC
• Contracts of employment

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Loads of rules.

• Common Law
• Data Protection Act 1998
• Human Rights Act 1998
• Professional Guidance-GMC,NMC,others
• Contracts of employment

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What we need to know

• Data protection principles
• Caldicott Principles
• Confidentiality Rules

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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

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Caldicott Principles

• Justify the purpose
• Don't use patient-identifiable information unless
  absolutely 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

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Donts

• 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 PDAs.
• Dispose of PID insecurely.

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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
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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, whos going to tell the doctor what
shes on ? Not me. Shes got 10 or 12 different
medicines and theres lots of stuff she cant
take patients recognise the value of sharing
information using information technology.
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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

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New guidance

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

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More treesor a third way ?

• Engage with public
• Engage with staff
• Involve patients
• (re)gain their trust

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New approaches - ECS

• mixed consent model
• Implied consent
• Option to opt out
• Explicit consent at point of access

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New approaches

• Supportive
• Collaborative
• Staff training
• Processes and procedures

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eHealth Governance

• Review of consent and confidentiality
• ( Spring 2008)

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Not sorted .

• Not even in England.

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..in the end..

• Thomas More ? beheaded
• Cromwell ? beheaded
• Archbishop Cranmer ? beheaded
• King died of syphillis !

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Do we need rules ?
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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

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thank you