The Health Care Institution
and Other Stakeholders
This chapter deals with the rights and duties of health care institutions relative to the electronic patient record and the electronically based information that is developed in the institutional setting. However, before dealing with the various issues that arise under this rubric, it may be appropriate to clarify some of the key concepts involved: in particular, the concept of an institution as a moral entity whose actions can legitimately be evaluated in ethical or moral terms.
In the contemporary world, health care is generally provided in an institutionalised setting. This setting may be localized in a building or set of buildings; however, that need not be the case. The actual delivery of the health care may be multi-centred, where each of the various geographically distributed parts of the institution provide different types and levels of service. An example of this would be a geographically distributed, vertically integrated health care institution that provides acute care in one locale, preventive care in another, cancer treatment in a third and extended care for elderly patients in a whole variety of distinct locations. Finally, institutionalised health care may be provided independently of any buildings whatsoever, as is the case in some countries where itinerant health care professionals provide health care services by travelling throughout their respective regions, and where only the administrative services are centralized in one location.