Abstract
We are on the threshold of developing the most comprehensive, detailed and powerful database of information that has ever existed. The development of a “womb-to-tomb” computerized medical record promises to remake not only the entire landscape of health care delivery systems, but also to alter fundamentally our notions of human identity in the information age. Within the medical context, some of the most intimate, detailed and potentially devastating bits of information are collected. This information is often collected when we are hurt or sick and vulnerable to those people whom we entrust with our care during a crisis. The information thus rendered sheds light on aspects of ourselves that in nearly every other context we might otherwise keep to ourselves.
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Notes
will use the term “health information” in place of “medical record” throughout this paper.Detinitionally speaking, I am referring to all information collected by an individual which relates to their physical. mental state, care, treatment or payment for such treatment. I am,lItempting to broadly define this information beyond that traditionally known within the context of the notes taken or created by a doctor/nurse and contained in a paper tile in a medical office. We will look more closely at the implications of this definition later in the paper.
The author was recently invited to address a committee at the National Academy of Sciences analyzing security in computerized patient records. The committee stated at the outset of the discussion that its task was to analyze the security of patient records in terms of a “threat model.” Threats were defined as those things which might “breach” the security systems designed to protect medical records. It was clear from the discussion which ensued that the committee had completely neglected to address the more real threats posed to confidentiality by those who would be granted permission to access computerized medical records. The paradigm was shifted away from threats to medical confidentiality and toward threats to computerized medical records security.
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See Christine Gorman, Big Brother Wants You Healthy, Time, 62: May 6, 1996. This article describes various schemes imposed by employers where employees may be fired or fined if they engage in certain behaviors such as smoking or failing to wear seat belts.
See Lawrence O. Gostin, Health Information Privacy, Cornell Law Review, Spring, 1995
Richard S. Dick and Elaine B. Steen, eds. (Washington, D.C., National Academy Press, 1991)
U.S. Congress, Office of Technological Assessment, Protecting Privacy of Comouterized Medical Information: Washington. D.C., U.S. Government Printing Office: 1993 Sep., No.: OTA-TCT-576, p. 23. Diagram created by the American Health Information Management Association based upon information taken from 10M report The Computer-Based Patient Record: An Essential Technology For Health Care.
The White House Domestic Policy Council, The President’s Health Security Plan; 123, (Times Books, 1993)
Id. at 128.
Public Law: 104–191. Subtitle F, Part C.
Statements on Introduced Bills and Joint Resolutions, Senate October 24, 1995; Statement of Senator Robert Bennett. 2nd Session, 100th Congress; S. Rep. No._
Alex Brown, Inc. at 21.
PRNewswire, October 25. 1995: Minnesota Takes the Lead On Agreement to Protect 41 Million Americans: at I.
Grove Press. Emeryville. California, 1996
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Breitenstein, A. (1997). U.S. Health Information Privacy Policy: Theory and Practice. In: Anderson, R. (eds) Personal Medical Information. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59023-8_18
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DOI: https://doi.org/10.1007/978-3-642-59023-8_18
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