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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
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.
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.