CCTOS: Trust and Responsibilities

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Draft Version 6.5, 10 May 2011, Etienne Saliez, ---- Next - Previous - Index of CCTOS Issues,  

• Issues:
  • Information of unknown origin could not be trusted.
    
  • Different actors could have sometimes different valuable opinions about the same set of observations.
  • Legal requirement of traceability.
    
• Approaches:
  • In order to add new information, the user must be be qualified and accredited as a member of the care team of the patient.  For example a prescription depend on 2 conditions: be given by a doctor who is currently member of the Care Team.  For example the pharmacist chosen by the patient is considered as a temporary member of the Care Team.
  • Any member of the Care Team may introduce comments, but the responsible author must always remain visible.
    
  • The computer network is neutral and different medical opinions are allowed to be recorded alongside, always mentioning the responsible author.
    
  • Someone else than the original author should be able to express his opinion, approving or disagreeing.  The system must be able to record this kind of "co-signature" of the original document.  The point is here to prevent Care Team colleagues to create unnecessary new copies of the same documents.
  • Versioning:
    • Update of Items are normally never allowed, but only new versions.  This should be true for all Items, even including the patient identification.
    • For medical reason it may be important to be able to go back to a previous step.
    • Also a mandatory legal requirement.  A decision is acceptable according the "rules of the arts" in function of all what was known at the time of that decision.
  • Responsibility:
    • The responsibility of the expert is limited to what is possible to say about the provided electronic information.