LEVERAGING INFORMATION TECHNOLOGY FOR COLLABORATION IN CLINICAL TRIALS - Collaborative Computational Technologies for Biomedical Research - page 298

• Confi dence that a message really is coming from the purported source
• Confi dence that it has not been altered in transit
• Ability to identify which population the message comes from (different
population group may have different assumptions about security)
• Ability to identify the exact individual from whom the message comes
• Ability to identify each individual or institution by a unique identifi er
• Point - and - click features so that a reference to an abnormal laboratory
result, for example, can be linked to the relevant laboratory reporting
system and record
• Support of digital signatures for nonrepudiation
• Cryptography

that can prevent any attempts at intervention and

eavesdropping
• Ability to mark messages with an indication of clinical importance or
“ level of emergency ”
• Delivery confi rmation for audit
• Automatic expiration after the date when they cease to be relevant
• Long - term archiving for future references

Special capabilities are required for provision of confi dentiality and protec-
tion of privacy for the clinical e-mail messages or attachments. They include
the ability to control access based on roles and identity; the ability to limit
copy, print, and transfer, leaving an audit trail of everyone that has received
and read sensitive information; and delegation and escalation. That last item
is the ability to authorize a third party (say an assistant) to review a practitio-
ner's mail. There should be the ability to link a clinical message to a specifi c
patient, provider, and setting. When patients are referred to in messages, they
must accompany some kind of a link to unique identifi er or some other strat-
egy for ensuring that the communication gets fi led correctly. Various types of
images, video clips, audio clips, and other attachments must be supported.
There must be automatic sorting by patients to see all communications about
an individual, by a practitioner to see all consults from a particular practitio-
ner, by a provider (e.g., hospital) to see all communications pertaining to a
particular practice environment, by priority, and by expiration date. There
should be an auto-archiving feature. There should be automatic fi ling of mes-
sages by patient, or some other attribute, including automatic forwarding of
messages to an electronic medical record system (after de-identifi cation, of
course!). There should also be clipboard support, that is, the ability to quickly
copy materials from a message into a medical record, for example.
In addition to the special properties of the clinical e-mail system required
for secure exchanges of health-related messages and documents with confi -
dentiality, integrity, privacy (e.g., informed consent, de-identifi cation of per-
sonal information), nonrepudiation (e.g., using digital signature and delivery
confi rmation), and auditability, the clinical e-mail system also needs to provide