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EHR Privacy Debate Heats Up
CurtMonash writes "The New York Times reports on President-Elect Obama's continued commitment to electronic health records (EHRs), which on the whole are a great idea. The article cites a number of legislative initiatives to deal with the privacy risks of EHRs. That's where things start to go astray. The proposals seem to focus on simply controlling the flow of information, but from a defense-in-depth standpoint, that's not enough. Medical care is full of information waivers, much like EULAs, only with your health at stake. What's more, any information control regime has to have exceptions for medical emergencies — but where legitimate emergencies are routine, socially-engineered fake emergencies can blast security to smithereens. So medical information privacy will never be adequate unless there are strong usage-control rules as well, in areas such as discrimination, marketing, or tabloid-press publication. I've provided some ideas as to how and why that could work well."
The danger of an Electronic Health Record is that it may perpetuate mistakes which of course do happen and any mistakes can carry on and lead to more problems. Sometimes for people with mental health problems, a diagnosis is made and then subsequently it's discovered that that was not the actual diagnosis. Having this kind of an electronic trail to follow you around forever could be extremely dangerous, in my opinion.
This game will waste your life. Don't clicky!
I saw this the other day. Basically, a pair of professors, one in law and another in computer science (specializing in software testing) are trying to bring the problems with EHR to a wider audience.
They call for testing and certification of EHR systems (Though thankfully not through the FDA).
It'll be interesting whether anyone listens to them.
$emails = $DB->get('SELECT email FROM records WHERE records.dysfunction LIKE "%erectile%"');
foreach( $emails as $email ){
mail($email, 'hello i hear you are in need of herbal via....');
}
One of the problems with EHR is that it potentially follows you your entire life.
If information about your economic status, familiar situation, physical location, customs, etc. Usually becomes unreliable after some time. A leak on those informations slowly loses effect.
Medical information, however, is permanent in many cases. A single leak of a person's data can have fresh information for, literally, a lifetime.
banking has a network for wire transfers that is not accessible from the internet. Make electronic medical records transferable and accessible only from within a closed off network. Then information can not be stolen from an outside attacker and you are left with the same risk you had before, insiders stealing data.
This has been in place in many other countries for years, including the UK where - for all the bureaucracy and wastage of the NPfIT initiative - it's been largely successful.
The system isn't perfect, and human error is the main source of problems and breaches (as ever), but the benefits have so vastly outweighed the risks that I'm surprised this is even being debated.
Most importantly, all the problems envisaged by critics have already been anticipated, encountered and (largely) overcome in other countries. Take a look outside your borders and learn a few things. Find out what works and what doesn't, and use the mistakes of others to build a better system. Just don't start panicking over nothing. This is not a pioneering initiative, in global terms.
Meta will eat itself
Essentially what you need is DRM. The data is only available on a limited number of machines and then strictly limited in what you can do with it, with strong audit trails. Not using general purpose computers but rather devices might help.
But in the end I don't think this is likely to work, the incentives for hacking are too strong and the distribution has to be too wide. EHRs mean that there will be substantially less medical privacy in exchange for better medical care and lower costs (70b-300b / year). That doesn't seem like a bad trade.
USA TODAY, circa 2015:
"It has reported that a laptop has been stolen, allowing thieves to gain access to over 1 million patients' records. Officials lied.... er, reassured the public that no harm has been caused."
"I disapprove of what you say, but I will defend to the death your right to say it." - historian Evelyn Beatrice Hall
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A doctor dictates his diagnosis into a microphone on a PC. It becomes a data file. It sits in his output queue. It is then sent to a server to be electronically signed (a Word Macro is run). It sits on it's input queue until done then sits in its output queue. Then it gets sent to an HL7 routing engine where it sits on queues. Then on to our medical database. This generates some billing info which goes to the HL7 router then on to a private company in Tennessee, which sends results to a website....
Now I'm sure there will be controls on who can get at the medical database. But what about the data whizzing around the network? Tell me about the audit trail that lets me know who saw some of the info generated by that one encounter. Because it sat on at least 7 machines in 3 states for some amount of time.
And now you want each of those machines to check to see if the patient has signed off on that machine getting the info? Good luck with that.
And if someone shows up unresponsive in the ER, how do we send the X-ray to the remote radiologist if the patient can't release the data? And if 'emergencies' override that control, expect to see EVERY encounter be an emergency.
Funny this should come up, considering what I just read last night in the RISKS Digest:
The proposition that EHR are a good idea remains as unproven as the idea that touchscreen voting machines with no paper trail are a good idea. Sometimes electronic documents and records introduce brave new failure methods that outweigh any benefit.
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
I am by no means rich and have been privately insured all my working life in the UK.
When I need to be treated quickly I go for private insurance, for long term treatment I rely on the NHS.
IANAL but write like a drunk one.
Whose information is that?
The patient's.
Who should control it?
The patient.
Any other solution should not be allowed to prevail.
An intelligent card, easy to back up at home and protected by well thought of security mechanisms is all what is needed.
There is no need for massive centralized databases, you just send the encrypted information to the person that needs to see it in an "as needed basis", perhaps by swapping your card in terminals connected to a private network that allows the sharing of this data.
IANAL but write like a drunk one.
I completely agree. I do not understand, whatsoever, how it is burdensome for a patient to bring their medical records to their doctor. The doctor and/or hospital keep those records privately; access and review/add to them when necessary--- and if the patient needs to see another doctor, they can get a copy and carry them on over to the new doctor.
This is how it already works; this is NOT a big deal.
Have you ever read your records?
They ALL have errors. And omissions. Lots of them. Often important ones. There is even relevent information that is not included with them.
It won't get better with electronic records. It will probably get worse (one universal input format). The (unwilling) doctor will be expected to enter the information into the computer. As a result, the information will be notated on paper or recording device (more errors) and transcribed (yet more errors). Then any information that does not fit into a standardized category will be lost. Wow, what an improvement!
Not to mention the fact that my records will now be public for all intents and purposes. At least with paper records you have to know what doctors I have seen and have to physically find and access them.
Unfortunately life is never that simple.
Medical records may contain information that the patient should not see - or to put it better - doctors constrained by the restriction that the patient sees everything will not provide optimal health care. For example, if a doctor suspects a patient is an alcoholic, but letting the patient know that will cause them to stop seeing the doctor ... how should that be documented? If we say the patient owns their records and can see everything then doctors simply won't document these things at all, which is not an optimal outcome.
Also - can we hold doctors legally liable for information in the health record if they themselves do not have access to it? This is a thorny issue. I would not like to be held responsible for information that I cannot even myself view. What happens if a doctor thinks of a complication after the patient left?
> What if the patient loses his/hers card?
What if the government or insurance company loses the card?
> What if his in an emergency and happens not to walk with that card in the pocket?
Gee, I don't know. What do they do now?
> Also, these information is not relevant only when the patient is in front of a
> doctor - sometimes, the case is reviewed by a board, or acessed for preventive
> care... or for scientific research or juridical purposes.
Did I consent to my medical records being public or semi-public? I don't care what the purpose is. My medical information is private and no one has the right to that information unless I (not the government) gives it to them. Ok?