1. Enforceable Specification of Privacy Peter Mork Jean Stanford CEM IR&D

2. © 2011 The MITRE Corporation. All rights reserved 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

3. © 2011 The MITRE Corporation. All rights reserved Background Paper consent forms prevent seamless health information exchange VA DoD

4. © 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

5. © 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

6. © 2011 The MITRE Corporation. All rights reserved Highlight Request Server (e.g., hData) Record Holder Server EHREHR BrowserBrowser Consent Server Consent DB Policy Reasoner Policy Enforcer

7. © 2011 The MITRE Corporation. All rights reserved Demonstration Allow Direct Care Providers X = Primary Care Provider Referral from X to Recipient Purpose = Treatment Allowed Categories MedicationsAllergies ¬ Mental Health Purpose = Treatment Dr. BlassResearch Purpose = Research Anonymized¬ Imagery ¬ Mental Health Purpose = Emergency ¬ Mental Health Dr. Walsh: Purpose = Treatment Dr. Walsh: Purpose = Treatment (Medications or Allergies) and not Mental Health

8. © 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/https://sourceforge.net/projects/kaironconsents/

9. © 2011 The MITRE Corporation. All rights reserved Future Plans Policy Maturity Accepted Practices Inchoate Technical Complexity Low High Preemptory Access Patient Review & Approve Integrate with State Mandates Intelligent Redaction Credential Matching Eliciting Patient Preferences Automated Enforcement Implemented Grand Challenges Under Development Integrate Care Relationships Audit