The mixed management of patients' medical records: responsibility sharing between the patient and the physician.

Through this article, we propose a mixed management of patients' medical records, so as to share responsibilities between the patient and the Medical Practitioner by making Patients responsible for the validation of their administrative information, and MPs responsible for the validation of their Patients' medical information. Our proposal can be considered a solution to the main problem faced by patients, health practitioners and the authorities, namely the gathering and updating of administrative and medical data belonging to the patient in order to accurately reconstitute a patient's medical history. This method is based on two processes.

Centralised versus decentralised management of patients' medical records.

For more than 20 years, many countries have been trying to set up a standardised medical record at the regional or at the national level. Most of them have not reached this goal, essentially due to two main difficulties related to patient identification and medical records standardisation. Moreover, the issues raised by the centralisation of all gathered medical data have to be tackled particularly in terms of security and privacy.

New advanced technologies to provide decentralised and secure access to medical records: case studies in oncology.

The main problem for health professionals and patients in accessing information is that this information is very often distributed over many medical records and locations. This problem is particularly acute in cancerology because patients may be treated for many years and undergo a variety of examinations. Recent advances in technology make it feasible to gain access to medical records anywhere and anytime, allowing the physician or the patient to gather information from an "ephemeral electronic patient record".

Giving patients secure << Google-like >> access to their medical record.

The main problem for the patient who wants to have access to all of the information about his health is that this information is very often spread over many medical records. Therefore, it would be convenient for the patient, after being identified and authenticated, to use a kind of specific medical search engine as one part of the solution to this main problem. The principal objective is for the patient to have access to his or her medical information at anytime and wherever it has been stored.

Watermarking medical images with anonymous patient identification to verify authenticity.

When dealing with medical image management, there is a need to ensure information authenticity and dependability. Being able to verify the information belongs to the correct patient and is issued from the right source is a major concern. Verification can help to reduce the risk of errors when identifying documents in daily practice or when sending a patient's Electronic Health Record.

Building application-related patient identifiers: what solution for a European country?

We propose a method utilizing a derived social security number with the same reliability as the social security number. We show the anonymity techniques classically based on unidirectional hash functions (such as the secure hash algorithm (SHA-2) function that can guarantee the security, quality, and reliability of information if these techniques are applied to the Social Security Number). Hashing produces a strictly anonymous code that is always the same for a given individual, and thus enables patient data to be linked.

Proposal of a French health identification number interoperable at the European level.

The French ministry of Health is setting up the Personal Medical Record (PMR). This innovative tool has long been expected by French Health Authorities, Associations of Patients, other Health's associations, those defending Individual Liberties and the French National Data Protection Authority. The PMR will lead to improvements in many areas such as Diagnosis (Research and monitoring) Healthcare (Management of emergencies, urgent situations, Temporal health monitoring and evaluation), Therapy (Cohorts of patients for Clinical trials and epidemiological studies).

How to manage secure direct access of European patients to their computerized medical record and personal medical record.

The multiplication of the requests of the patients for a direct access to their Medical Record (MR), the development of Personal Medical Record (PMR) supervised by the patients themselves, the increasing development of the patients' electronic medical records (EMRs) and the world wide internet utilization will lead to envisage an access by using technical automatic and scientific way. It will require the addition of different conditions: a unique patient identifier which could base on a familial component in order to get access to the right record anywhere in Europe, very strict identity checks using cryptographic techniques such as those for the electronic signature, which will ensure the authentication of the requests sender and the integrity of the file but also the protection of the confidentiality and the access follow up. The electronic medical record must also be electronically signed by the practitioner in order to get evidence that he has given his agreement and taken the liability for that.