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."

Comments

Unlikely

[professorguy]

OK, I run a hospital network, so I see medical data whizzing around more than most people. Here's a typical example:

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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.