A governance model vigilant of the ownership and privacy questions concerning the electronic health record in Canada is required.  This model should benefit patients, and remove legal ambiguities for clinicians, researchers and industry to help advance research, diagnosis and treatment of patients and ultimately save lives.  In evaluating the various governance possibilities, the interests of each stakeholder group must be considered, and balanced against the interests of society as a whole in promoting medical research, and the diagnosis, treatment and prevention of disease.   

This paper has illustrated the significant complexities that surround the design and implementation of the electronic health record.  Although the potential benefits of the EHR are indisputable, legal implications must be considered thoughtfully.  This is especially important given the interoperable nature of the EHR, and consequent sharing of medical data on large-scale electronic networks.

Certainly issues of privacy, confidentiality and security cannot be ignored.  As illustrated in this paper, the harmonization of privacy legislation nation-wide will be essential to the sharing of electronic health information across borders.  In addition, questions concerning the secondary or non-clinical uses of EHR systems should be more adequately addressed.  The clarification of ownership, control and access issues subject to intellectual property protection is essential.  The prevailing uncertainty as to who owns or controls what will very likely hinder the benefits of eHealth and present disadvantages to forming the type of public-private partnerships that drive innovation and research in Canada.



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