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Google to Begin Storing Patients' Health Records
mytrip writes with news that Google's health record archive is about to be tested with the assistance of the Cleveland Clinic. Thousands of patients (who must approve the transfer of information) will have access to everything from their medical histories to lab results through what Google considers a "logical extension" of their search engine. We discussed the planning of this system last year.
"Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that's also required to use other Google services such as e-mail and personalized search tools. The health venture also will provide more fodder for privacy watchdogs who believe Google already knows too much about the interests and habits of its users as its computers log their search requests and store their e-mail discussions. Prodded by the criticism, Google last year introduced a new system that purges people's search records after 18 months. In a show of its privacy commitment, Google also successfully rebuffed the U.S. Justice Department's demand to examine millions of its users' search requests in a court battle two years ago."
Now I'm going to get TARGETED Viagra spam....
It's Cleveland Clinic, and it's pretty much in every major city. So there are more people affected then just in Cleveland.
When your email is parsed for relavent ads, many just let that go.
But when you associate my email, calendar, documents, health info and who knows what's next, I start to wonder if that might not be too many eggs in one basket?
And if you are like me, your handle/username/login is the same across many sites.
On one hand, it would be convenient to have this archive available so that we can access our records without the hassle of dealing with the healthcare system. On the other side, all that data has only the strength of your password standing between it and the Black Market.
Cleveland Clinic is one of the top healthcare institutions in the US and the world. Calling it "a clinic in Cleveland" is like calling the New York Times web site "some guy's blog"...
my former employer offered us the option to buy into an online health records system. the selling points were that we could easily be sure that any doctor we saw could have instant access to all of our history, and we could review treatments and billing records.
I chose not to participate, because the provider was new and unknown to me. I don't think I would want to use Google, because they ARE known to me.
I'll just keep asking for copies of records when I visit a doctor, and keep them in my filing cabinet.
Actually, HIPAA does not cover third party databases.
Can I log in and see everything myself? And can I see the list of everyone who ever accessed my records? If not, it's no good.
Google has done a great job in searching raw free-text data. However, healthcare data is a different beast. The sheer number of datatypes is mind-boggling -- the number of different labs, drug classes, diseases etc that can get coded in patient records runs in to millions. So over the years healthcare databases have been constructed differently - they follow an EAV (Entity Attribute Value) representation, which means that the patient databases are generally just ONE BIG TABLE! Here is the database schema used at New York Presby. Schema - all past 20 years patient data is stored in one table! oh yeah.. DB2 Baby!
Essentially all data/knowledge complexity is present in the Ontology/Terminology (such as SNOMED or LOINC) and the patient data itself instantiates from these.
Also doing NLP over medical notes is a difficult problem requiring years of tuning and domain knowledge to construct one -- which again is so specific to a given institution or region that it just does not work elsewhere.
It would be interesting to see what *real* innovations Google brings on the table.Here's some of the problems you can have when the confidentiality of your medical records is compromised.
http://www.post-gazette.com/pg/06362/749444-114.stm
WSJ, 26 Dec 2006, Medical dilemma: spread of records stirs patient fears of privacy erosion; Ms. Galvin's insurer studies psychotherapist's notes; a dispute over the rules; complaint tally hits 23,896, Theo Francis.
(My notes, for people who are too lazy to even click on the link:)
In 1996, after her fiance died suddenly, Patricia Galvin left New York for San Francisco and was hired by Heller Ehrman LLP.
In 2000, Galvin began psychotherapy sessions at Stanford Hospital & Clinics with clinical psychologist Rachel Manber, who discussed her problems at work, her fiance's death, and her relationships with family, friends and co-workers. Manber assured Galvin that her notes would be confidential.
"I would never have engaged in psychotherapy with her if she did not promise me these notes were under lock and key."
In 2001, Galvin was rear-ended at a red light and suffered 4 herniated disks, which worsened.
In 2003, she applied for long-term disability. Her employer's carrier, UnumProvident Corp., said it would deny her claim unless she signed a release.
Manber assured Galvin her therapy notes would not be turned over. 3 months later, Unum denied her claim, because of psychotherapy notes about "working on a case" and a job interview in New York, which, Unum said, showed she was able to work. Galvin says they misinterpreted the notes.
In 2004, Galvin sued Manber, Stanford and Unum for malpractice and invasion of privacy, under California law. Galvin said "my most private thoughts, my personal tragedies, secrets about other people" were exposed.
In 2005, Galvin learned that Stanford had scanned Manber's notes into its system, making them part of her basic medical record. Stanford sent this file to Unum and the other driver.
Stanford said that "psychotherapy notes that are kept together with the patient's other medical records are not defined as 'psychotherapy notes' under HIPAA." It would be "impracticable" to keep them separate.
The health-care industry is scanning documents into electronic record systems. HIPAA gives psychotherapy notes special protection, but not when mixed in with general medical records.
Peter Swire, law professor, Ohio State U., explains why they wrote the rule giving confidentiality only to separate psychotherapy notes.
Stanford refused to separate her psychotherapy notes from other medical records. "Any time anybody asks for my medical records, my psychotherapy notes are going to be turned over."
In 2006, DHHS rejected Galvan's HIPAA complaint. From Apr-Nov 2003, DHHS had 23,896 privacy complaints, but hasn't taken any action. HIPAA exceptions allow release in connection with "payment" or "health-care operations."
Galvan, 51, is representing herself, because she couldn't find a California attorney with privacy experience.
Deborah Peel, Austin TX, psychiatrist and head of Patient Privacy Rights, says, "How many women want somebody to know whether they are on birth control?"
http://online.wsj.com/article/SB116709136139859229.html
NYT, 26 Dec 2006, Costs of a crisis: Diabetics confront a tangle of workplace laws, N.R. Kleinfield.
Some companies fire diabetics for ostensible safety reasons, even though there's no evidence that they're unsafe. Courts nationwide have split on whether diabetes is a disability under the test that a "major life activity" is "substantially limited".
John Steigauf, 47, was a truck mechanic for United Parcel Service, but UPS put him on leave because of his diabetes. UPS claimed his blood sugar might plummet while he tested a truck, causing an accident, and he couldn't get an interstate commercial driver's license with insulin-dependent diabe