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Electronic Patient
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Electronic Patient Data
System Raises Privacy Concerns
Other Topics: Global
BioInformatics Market to hit $3B by 2010,
American Medical Informatics
Association AMIA to address Nursing Informatics
Shreema Mehta
The
NewStandard
July 25, 2006
To the chagrin of privacy advocates, the Bush administration is
making moves toward creating a nationwide system of electronic
medical records that that would allow access to a patient’s data
anywhere, any time.
The administration argues that electronic conversion will help
reduce medical error and improve emergency care by making
patient data more immediately accessible. Government agencies
will also be able to better monitor outbreaks with electronic
records that can be transferred immediately from a hospital to
an agency like the national Centers for Disease Control,
allowing them quicker access to critical data |
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Medical-privacy
advocates, however, say digitized patient data linked on a
nationwide or even statewide scale could threaten patients’
privacy rights, especially in conjunction with loosened medical
privacy laws. "The more data is linked up, and the more we build
an electronic superhighway, the more people can tap into it,"
said Deborah Peel, a psychiatrist and founder of Patient Privacy
Rights.
Peel and other privacy advocates are worried that if a system
lacking strong safeguards is launched, patients will begin
limiting the amount of information they tell their doctors for
fear that information will haunt them in other parts of their
lives, such as insurance or employment.
In April 2004, the Bush administration appointed the first
National Coordinator for Health Information Technology to use
the federal government’s leverage as a major purchaser of
healthcare services to encourage hospitals to use electronic
instead of paper records.
The Office of the National Coordinator (ONC) seeks to eventually
build a national network of health data by encouraging the
development of "regional health information organizations" that
enable local healthcare entities to share data. The ultimate
goal is to then link those regional networks with each other.
This week, the ONC is holding another round of public meetings
to discuss how best to encourage the conversion to electronic
records and how to build a national network of groups that share
patient data.
An ONC report released last month stated, "By bringing personal
health information about patients, evidence about treatments,
and preventative and research information to healthcare
professionals, electronic health records and other health
[information-technology] tools can substantially improve care
delivery by reducing errors caused by lack of information and by
reducing costs from redundant care."
But Peel said digitizing and sharing patient information can
overexpose records to loss and theft, as well as violate privacy
rights. She also called the Bush administration’s argument that
an electronic system is crucial to providing emergency care,
such as during hurricanes, a "very red herring."
Peel says the potential benefits of an electronic system are
being touted to push a scheme that is overbroad in terms of who
will ultimately have access to the records.
"Of course, having more medical information in an emergency is
helpful," she said, but the federal government is using that
"single, isolated case to justify opening up the medical records
of 290 million people."
But Susan Stuard, who oversees health information technology for
the Greater New York Hospital Association, said that when
digitizing patient data, hospitals implement safeguards,
including passwords and audit trails that allow them to track
who viewed which patients’ records.
"Privacy concerns for the paper record are already very strong,"
she said. "So when you go from paper to a person’s electronic
[record], you’re modifying these processes, and the privacy
restrictions are just as strict."
But privacy groups say that current privacy regulations are not
strong enough. In addition to doctors and nurses,
health-insurance companies, employers that fund their own health
plans, and law-enforcement agencies can get access to patients’
records without their express permission.
In 2002, the Department of Health and Human Services removed the
patient-consent requirement of the Health Insurance Portability
and Accountability Act (HIPAA) of 1996. The Act required
healthcare workers to obtain a one-time authorization from
patients for the disclosure of their health information to
insurance companies or business associates from then on. But
under the revised rules, healthcare providers no longer need
their patients’ permission to disclose data to authorized third
parties.
Peel said that while the 2002 HIPAA modification left patients
more vulnerable to privacy-rights violations and possible
employee discrimination, the creation of a linked
electronic-data system that insurance companies and employers
can easily access will make the problems worse.
Many regional data-sharing organizations include insurers among
their collaborators, giving insurance companies the same easy
access to data that doctors will have.
The Department of Health and Human Services defines regional
health information organizations, or RHIOs, as collaborations
between healthcare providers. But the RHIO Massachusetts eHealth,
for example, counts Blue Cross Blue Shield Massachusetts and the
Massachusetts Association of Health Plans – two insurance
providers – among its members.
Peel said these RHIOs will exacerbate the problem of insurers
using personal health data to exclude people from coverage.
"It’s true that insurers and employers are collecting
information [from paper records], but it’s laborious with the
paper system. They have to get [documents] faxed and sent to
them," she said. "If they tap into the database, they don’t have
to go through somewhere else."
Advocates say that because the government is still drafting its
plan to encourage the shift to electronic records and the
creation of a national network of patient data, the severity of
privacy threats is still unclear.
Joy Pritts, founding director of the Center of Medical Record
rights and Privacy at Georgetown University, said, "It all
depends on how the system shakes out, and it’s not clear how
this will develop in the long run."
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