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Enforceable Specification of
         Privacy
          Peter Mork
          Jean Stanford


            CEM IR&D
Problem
 Growing need for Health Information Exchange
   – Continuity of care
   – Decreased costs
   – Public health reporting
   – Facilitate clinical research
 Health Information Exchange requires patient consent:
   – Paper-based
   – One form per transaction
   – Non-transferrable
   – Signed with limited time to think




                                                   © 2011 The MITRE Corporation. All rights reserved
Background




                                          DoD




             VA
                    Paper consent forms
                  prevent seamless health
                   information exchange


                               © 2011 The MITRE Corporation. All rights reserved
Objective
 Support Meaningful & Granular Patient Consent
 Globally Accessible by:
   – Patients and
   – Record Holders
 Platform Adaptable
 Modular Design adapts to:
   – Technology Changes
   – Legal Changes




                                                  © 2011 The MITRE Corporation. All rights reserved
Activities
 Developed rules language for consent:
   – Basic constructs = purpose, topics, datatypes, time, etc.
   – Two forms of negation
   – Terminological hierarchies
   – Reusable knowledge components
 Policy reasoner:
   – Input = Patient preferences + request
   – Output = Minimized rule tree
 Policy enforcement:
   – Conversion to XACML
   – Prototype of EHR with XACML engine



                                                     © 2011 The MITRE Corporation. All rights reserved
Highlight
                            Request Server
            Browser
                             (e.g., hData)




    Record Holder Server                        Consent Server



                 Policy                                    Policy
                 Enforcer                                 Reasoner
  EHR                                        Consent DB




                                                          © 2011 The MITRE Corporation. All rights reserved
Demonstration
                                                                         X = Primary
                                                                        Care Provider
                                          Direct Care
                                           Providers
                                                                        Referral from
                                                                        X to Recipient
                                          Purpose =
       Dr. Walsh:                         Treatment
       Purpose =                                          Medications
                                           Allowed
       Treatment                          Categories
                                                           Allergies
                                           ¬ Mental
                                            Health

                                          Purpose =
                                          Treatment

                    Allow
                                           Dr. Blass


                                                                         Purpose =
       (Medications or Allergies) and not Mental Health                  Research


                                                                        Anonymized
                                           Research
                                                                          ¬ Imagery
                                          Purpose =
                                          Emergency
                                                                          ¬ Mental
                                                                           Health
                                           ¬ Mental
                                            Health
                                                                          © 2011 The MITRE Corporation. All rights reserved
Impacts
 Sponsor Engagements:
   – Office of the National Coordinator
   – Substance Abuse and Mental Health Services
     Administration
   – Department of Veteran’s Affairs
 Other Engagements:
   – Healthcare Information and Management Systems Society
   – GE Healthcare
   – United Health
 Open Source:
   – https://sourceforge.net/projects/kaironconsents/




                                                    © 2011 The MITRE Corporation. All rights reserved
High
     Future Plans

                                Automated                         Integrate with               Intelligent
                                Enforcement                       State Mandates               Redaction


                                                  Eliciting Patient                Integrate Care
                                                  Preferences                      Relationships                                             Implemented
 Technical Complexity




                                                                                                                                                Under
                                                                                                                                             Development

                                             Patient Review
                                             & Approve                                                                                          Grand
                                                                                                                                              Challenges




                                Preemptory                                                     Credential
                                                              Audit                            Matching
                                Access
Low




                        Accepted Practices                                                                            Inchoate
                                                                 Policy Maturity



                                                                                                             © 2011 The MITRE Corporation. All rights reserved

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Enforceable Specification of Privacy

  • 1. Enforceable Specification of Privacy Peter Mork Jean Stanford CEM IR&D
  • 2. Problem  Growing need for Health Information Exchange – Continuity of care – Decreased costs – Public health reporting – Facilitate clinical research  Health Information Exchange requires patient consent: – Paper-based – One form per transaction – Non-transferrable – Signed with limited time to think © 2011 The MITRE Corporation. All rights reserved
  • 3. Background DoD VA Paper consent forms prevent seamless health information exchange © 2011 The MITRE Corporation. All rights reserved
  • 4. Objective  Support Meaningful & Granular Patient Consent  Globally Accessible by: – Patients and – Record Holders  Platform Adaptable  Modular Design adapts to: – Technology Changes – Legal Changes © 2011 The MITRE Corporation. All rights reserved
  • 5. Activities  Developed rules language for consent: – Basic constructs = purpose, topics, datatypes, time, etc. – Two forms of negation – Terminological hierarchies – Reusable knowledge components  Policy reasoner: – Input = Patient preferences + request – Output = Minimized rule tree  Policy enforcement: – Conversion to XACML – Prototype of EHR with XACML engine © 2011 The MITRE Corporation. All rights reserved
  • 6. Highlight Request Server Browser (e.g., hData) Record Holder Server Consent Server Policy Policy Enforcer Reasoner EHR Consent DB © 2011 The MITRE Corporation. All rights reserved
  • 7. Demonstration X = Primary Care Provider Direct Care Providers Referral from X to Recipient Purpose = Dr. Walsh: Treatment Purpose = Medications Allowed Treatment Categories Allergies ¬ Mental Health Purpose = Treatment Allow Dr. Blass Purpose = (Medications or Allergies) and not Mental Health Research Anonymized Research ¬ Imagery Purpose = Emergency ¬ Mental Health ¬ Mental Health © 2011 The MITRE Corporation. All rights reserved
  • 8. Impacts  Sponsor Engagements: – Office of the National Coordinator – Substance Abuse and Mental Health Services Administration – Department of Veteran’s Affairs  Other Engagements: – Healthcare Information and Management Systems Society – GE Healthcare – United Health  Open Source: – https://sourceforge.net/projects/kaironconsents/ © 2011 The MITRE Corporation. All rights reserved
  • 9. High Future Plans Automated Integrate with Intelligent Enforcement State Mandates Redaction Eliciting Patient Integrate Care Preferences Relationships Implemented Technical Complexity Under Development Patient Review & Approve Grand Challenges Preemptory Credential Audit Matching Access Low Accepted Practices Inchoate Policy Maturity © 2011 The MITRE Corporation. All rights reserved