Nid ydym yn gwybod a yw'r ymateb mwyaf diweddar i'r cais hwn yn cynnwys gwybodaeth neuai peidio - os chi ywS.Jones mewngofnodwch a gadael i bawb wybod.

Dear Information Commissioner's Office,

What guidance is available on the accuracy of medical records, when patients disagree with doctors? Some doctors refuse to correct entries on the basis that it is a "clinical opinion"

The ICO website says "It is also complex if the data in question records an opinion. Opinions are, by nature, subjective. As long as the record is clear that the data is an opinion and, where appropriate, whose opinion it is, it can be difficult to maintain it is inaccurate and needs to be corrected."

1. Are medical records considered to consist only of clinical opinions?
2. Are facts such as life events, race, ethinicity nationality and occupation considered to be clinical opinions?
3. Would the ICO recommend that there is a clear distinction between facts and opinions within each clinical entry?

Yours faithfully,

S.Jones

Information Access Inbox, Swyddfa'r Comisiynydd Gwybodaeth

Thank you for contacting the Information Commissioner’s Office. We confirm
that we have received your correspondence.

If you have made a request for information held by the ICO we will contact
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answer your request. If we don't need any further information we will
respond to you within our published, and statutory, service levels. For
more information please visit:

[1]https://ico.org.uk/about-the-ico/our-inf...

If you have raised a new information rights concern - we aim to send you
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Yours sincerely

The Information Commissioner’s Office

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Swyddfa'r Comisiynydd Gwybodaeth

11 December 2019

 

Case Reference Number IRQ0895819

 

Dear S Jones

Request for Information
 
Thank you for your correspondence which we received on 6 December, in
which you have made a request for information held by the Information
Commissioner's Office (ICO). 
 
Your request has been passed to the ICO’s Information Access Team, and is
being dealt with in accordance with the Freedom of Information Act 2000
(FOIA) under the reference number shown above. 
 
As you are probably aware the FOIA provides individuals with the right of
access to recorded information held by public authorities. It is important
to note that a release under FOIA is applicant blind and therefore
effectively a release to the wider world.
 
We will respond to your FOIA request promptly, and no later than 8 January
which is 20 working days from the day after we received your request.
 
Should you wish to reply to this email please be careful not to amend the
information in the ‘subject’ field. This will ensure that your reply is
added directly to your case.
 
Yours sincerely
 
 

Hannah Silk
Lead Information Access Officer
Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow,
Cheshire SK9 5AF
T. 0330 313 1688 [1]ico.org.uk  [2]twitter.com/iconews
Please consider the environment before printing this email
For information about what we do with personal data see our [3]privacy
notice

 
 

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Swyddfa'r Comisiynydd Gwybodaeth

7 January 2020

 

Case Reference Number IRQ0895819

 

Dear S Jones

Request for Information
 
Further to our acknowledgement of 11 December we can now respond to your
request for information of 5 December.
 
We have dealt with your request in accordance with your ‘right to know’
under section 1(1) of the Freedom of Information Act 2000 (FOIA).
 
Request
 
In your email you asked:
 
“What guidance is available on the accuracy of medical records, when
patients disagree with doctors? Some doctors refuse to correct entries on
the basis that it is a "clinical opinion" The ICO website says "It is also
complex if the data in question records an opinion. Opinions are, by
nature, subjective. As long as the record is clear that the data is an
opinion and, where appropriate, whose opinion it is, it can be difficult
to maintain it is inaccurate and needs to be corrected." 1. Are medical
records considered to consist only of clinical opinions? 2. Are facts such
as life events, race, ethinicity nationality and occupation considered to
be clinical opinions? 3. Would the ICO recommend that there is a clear
distinction between facts and opinions within each clinical entry?”
 
Our response
 
The ICO does not hold any more detailed guidance on the distinction
between opinion and fact in relation to medical records than that which is
published on the web page to which you refer. In general such a matter
would be assessed on a case by case basis as these distinctions would
depend on the circumstances.
 
In terms of medical records, these are likely to contain a mixture of fact
and clinical opinion. As advised on the website, where an opinion is
recorded it should be clear that this is an opinion. In the case of
medical records, this is likely to be clear from the format of the
record. 
 
If you would like more detailed advice about the legislation we oversee,
we can assist you with this, however, we do not provide general advice
through the WDTK website. 
 
The WDTK website was created to help people request information from
public authorities under the Freedom of Information Act (FoIA) and the
Environmental Information Regulations (EIRs). This relates to requesting
any recorded information that public authorities may hold. However it is
not the correct channel for seeking advice.
 
To do so please contact our helpline on 0303 123 1113 where a member of
our team will be happy to assist you further.
 
If you would like to submit your enquiry in writing you should email it to
[1][email address]. 
 
If you have a concern about the way a particular organisation has handled
your personal data or dealt with any information rights requests you have
made to them you can do this by following the instructions on this page of
our website - [2]www.ico.org.uk/concerns.
 
This concludes my response.
 
Review Procedure
 
If you are dissatisfied with this response and wish to request a review of
our decision or make a complaint about how your request has been handled
you should write to the Information Access Team at the address below or
e-mail [3][ICO request email].
 
Your request for internal review should be submitted to us within 40
working days of receipt by you of this response. Any such request received
after this time will only be considered at the discretion of the
Commissioner.
 
If having exhausted the review process you are not content that your
request or review has been dealt with correctly, you have a further right
of appeal to this office in our capacity as the statutory complaint
handler under the legislation. To make such an application, please write
to our Customer Contact Team at the address given or visit our website if
you wish to make a complaint under the Freedom of Information Act.
 
A copy of our review procedure can be accessed from our website.
 
[4]https://ico.org.uk/media/1883/ico-review...
 
Yours sincerely
 
 

Hannah Silk
Lead Information Access Officer
Corporate Strategy and Planning Service
Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow,
Cheshire SK9 5AF
T. 0330 313 1688 [5]ico.org.uk  [6]twitter.com/iconews
Please consider the environment before printing this email
For information about what we do with personal data see our [7]privacy
notice

 
 
 
 
 

References

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Nid ydym yn gwybod a yw'r ymateb mwyaf diweddar i'r cais hwn yn cynnwys gwybodaeth neuai peidio - os chi ywS.Jones mewngofnodwch a gadael i bawb wybod.