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Re: [Gnumed-devel] CCHIT - access restrictions per SOAP note

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] CCHIT - access restrictions per SOAP note
Date: Sat, 7 Nov 2009 20:47:14 +0100
User-agent: Mutt/1.5.20 (2009-06-14)

On Sat, Nov 07, 2009 at 07:04:15PM +0100, Hilbert, Sebastian wrote:

> requirement:
> Enter some information to be identified as “confidential,” for example, that 
> the patient had once been a victim of domestic violence, into the chart and 
> designate as accessible only to Physician Users.
> This is handled at database level already ,isn't it ?

Not really. We encourage using cut-n-paste of GPG
encrypted text:

Doctor types "domestic violence victim, ..." into the soap
note. Doctor selects text. Doctor cuts text from soap note.
Doctor inserts text into GPG encryptor frontend and encrypts
it outputting ASCII armored data. Doctors cuts that from
encryptor. Doctors pastes ASCII armored text into soap note.

Reading this needs the reverse process.

This could use symmetric or asymmetric cryptography with
different degrees of confidentiality and different
protection properties:

using per-patient symmetric key:

        share key between patient and provider

using one symmetric key per provider for all patients:

        key only known to provider

encrypting with public key of patient:

        patient MUST consent to disclose content because
        only patient can unlock her private key

encrypting with public key of provider:

        only this provider can retrieve content because
        only provider can unlock his private key

The last two can usefully be combined.

One day we should support that from within GNUmed.

Signing of notes is actually quite similar: Just GPG-sign
the clear-text note (just like this e-mail is signed) and be
done with it.

GPG key ID E4071346 @
E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346

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