For assuring access to care

There is an ethical obligation to ensure that no person is denied access to an adequate quality of healthcare, irrespective of their ability to pay for it. In many nations this is a legal right, not merely an ethical one, representing a fundamental human right guaranteed by the constitution. The reality is that this objective is quite far off for most LMICs, but constitutes a fundamental objective to strive for. And further access is seen to have been achieved or to be coverage effective, only when there is evidence of good quality of care. The clinical case record makes both the access to care and the quality of care provided to individuals more transparent and verifiable, and therefore also the subgroup or population that we are concerned about.

For ensuring patient rights and autonomy in clinical care

In the name of public priorities, the state can encroach on civil liberties of individuals. For example, the state has a duty to ensure that every tuberculosis patient completes his or treatment, but on the other hand, the fact that a person has tuberculosis is confidential that only the patient has the right to reveal. The performance of the state duty towards protecting privacy, confidentiality, dignity, and the choice of the individual over his or her own body and decisions made about it, requires both design features, organization of work flows, and governance and regulatory features. The state’s duty to protect public health could often pull in opposing directions with implications for the interface between public health and clinical informatics. Whereas clinical information and records are essential, for most public purposes this data would be available only in its PHI form, which is as anonymized and aggregated.

All this leads to one inescapable conclusion—that the emerging discipline of PHI must be an amalgam of population-based information and individual health records. Here the needs of individuals seeking and providing care, and the needs of communities and governments to ensure the attainment of the highest level of health for the population are seamlessly integrated into a single health information architecture.

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