Last week's Daily Telegraph in the UK reveals the challenges we will face with EHRs in the United States if we do not change our perspective on the solution before cementing 19th century approaches into rules at HHS. "Patient's Medical Records Go Online Without Consent," by Kate Develin does an excellent job of looking at the implications of seeing this as a records problem rather than a patients problem.  EHRs divorced from the patients to whom they belong is at the heart of the digital debacle in Britain. The following quote is at the very heart of the privacy issue:

The "summary" records contain basic medical information including illnesses, vaccination history, and could include medication patients have been given. Ages and addresses are also included. (emphasis added)

The issue with privacy on the Internet today is that the data silos into which our records are poured not only include What I Am™ but Who I Am™.  The combination of critical health information, in this case, along with personally identifying information is at the heart of the privacy issue.  If one can separate Who I Am™ from What I Am™, then the privacy issue begins to change, since the NHS database may have the What, but it won't have the Who.  The patient, along with their doctor, are in charge of connecting Who to What.  No opting out... simply better control... and putting the ownership of the data into its rightful place, the individual. Approaches, like OpenID, regretfully, are only a part of the solution to this EHR ownership issue. By facilitating "logging in" to web pages and making it  possible to more quickly take all of my information and put it into yet another web and data silo, they don't change the privacy problem.  They accelerate it.  Their home page states this very clearly, "Log into 50,000 websites with a single username." Even the OpenID Foundation accepts the world of web sites as a given: "OpenID is a safe, faster and easier way to log into websites."  OpenID's challenge is that it accepts the browser and web paradigm of the past 15 years and does not go to the heart of the Internet that was ushered in by Vint Cerf and Bob Kahn 40 years ago. Katherine Murphy, of the Patients Association, quoted in the article, says it best: "The Health Service should not put in place bureaucratic obstacles to patient choice because they are worried about what patients might choose to do." CLOUD seeks to fix a broken Internet, so that patients can have that choice.