The following blog appeared a few days ago. The author is a physician and a past director of the US National Institutes of Health (NIH)
Electronic Medical Records: Will Your Privacy Be Safe?
February 17, 2009 02:16 PM ET | Bernadine Healy, M.D. | Permanent Link | Print
By Bernadine Healy, M.D.
Doctors are supposed to be nosy. It's not just that they examine your naked body inside and out and record all its imperfections. Physicians are trained to peer into your life, past and present, and ask all sorts of sensitive, if not uncomfortable, questions. Have you ever used marijuana or cocaine? How about steroids? How many sexual partners? Ever had a sexually transmitted disease? An abortion? Had sex with the same sex? How much do you smoke or drink? Have you used Botox or had plastic surgery? Have you been depressed or been treated for mental illness? And how about your marriage—or marriages?
You get the gist; the experience is intrusive. But the doctor-patient relationship was never meant to be other than confidential and privileged and solely for the benefit of the patient. Patients expect it, or they would not be forthcoming. And doctors take the Hippocratic oath, pledging to hold sacred their patients' secrets. This pledge of confidentiality, however, is now challenged by a world where computers rule and health information falls into many hands. One might well ask whether medical privacy is just too outmoded a concept for today's information-hungry world.
We had better decide. Electronic medical records have become a national goal, a way to replace the highly fragmented and inefficient paper system used in most medical settings today. President Obama has made revamping the medical system a top priority, with the national electronic medical record first up in healthcare reform. Indeed, the economic stimulus package assigns billions of dollars to that effort. In light of public sensitivity, this major jump-start for centralized records comes with provisions to further strengthen privacy laws.
However much we Facebook or Twitter about personal stuff, the public remains jittery about losing control of personal health information. Americans treasure their zone of privacy, and polls show they fear that government does not protect nearly well enough the medical information it already accesses. Clearly, once sensitive information is out there, it can't be brought back.
Look at Alex Rodriguez. A breached pledge to keep confidential those urine tests for steroids taken in 2003 has left his career a shambles, and 103 other players are waiting for their results to be leaked to the press, too. Their past transgressions notwithstanding, more than 1,000 ballplayers consented to these tests back then, with the understanding that results would be anonymous. The findings were to be destroyed after the league assessed the magnitude of the problem. (In a similar design years ago, anonymous HIV testing studies helped reveal the size of the AIDS epidemic.) The players' data led to what are now stringent drug testing and penalties, as there were none at the time.
It's easy to translate this situation to a violated personal medical record or, on a larger scale, a research study. Imagine if researchers culled the national health record for information on sensitive groups, whether they be HIV carriers or illegal-drug users. If one of the subjects in the study were under government investigation, might not the other records be sucked up in a sting? Not too far-fetched.
Much more here:
This post really puts into a few clear words the fears many have regarding electronic health records. Much of it is irrational, but it is real and as far as getting public adoption and acceptance perception is truly reality. Those proposing EHRs must clearly recognise and address the issue.
David.
2 comments:
This paper makes no reference to irrational fears.
Many governments and businesses are now coveting our information. We have no evidence on the long term effects of the use of such information. We may yet discover that these irrational fears have sound reasons.
I could not agree more with what is said in that post.
Medical-Communication is sensitive and should be between healthcare providers by deliberate choice, with patient access as appropriate. That communication should obviously be secured with encryption.
The concept of a shared EHR is flawed and for urgent access to records a well authenticated "Break the Glass" access to provider records by eg. A&E departments is more appropriate.
The focus needs to be on standards based provider - provider communication and not pie in the sky shared EHRs. Then the privacy concerns are no different to current practice.
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