Patient data confidentiality and patient rights

There has been a recent trend to gather and record more comprehensive and more detailed personal medical information in computerized databases. Retrieval and access are much easier from electronic records than from hard copies stored in the archives of care-providing institutions. The Institute of Medicine voiced concern that these developments raised numerous problematic issues, the most disturbing of which is a much more widespread and systematic violation of privacy via what they called 'authorized abuse', i.e. authorized users abusing their access privileges. Other worries stemmed from the sharing of patient information among different entities. Multitudes of organizations receive information about patients' health records, often without their knowledge or consent. These include care providers, insurers, pharmacists, employers, life insurance companies and marketing firms. This article addresses the issues of medical data ownership and some health data-recording problems to which we propose co-ownership and co-documentation as part of the solution. We believe that a cooperative approach will help to maintain greater accuracy of personal medical data, written in language that can be shared and understood by the consumers and not one couched in terminology understandable only to professional personnel and to delegate the power to the patient to decide when and to whom to give authorization for its use by a third party and for research.

[1]  C Safran,et al.  Sharing electronic medical records across multiple heterogeneous and competing institutions. , 1996, Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium.

[2]  B J McNeil,et al.  Rating the appropriateness of coronary angiography--do practicing physicians agree with an expert panel and with each other? , 1998, The New England journal of medicine.

[3]  I S Kohane,et al.  WHAM!: a forms constructor for medical record access via the World Wide Web. , 1995, Proceedings. Symposium on Computer Applications in Medical Care.

[4]  M. Gilhooly,et al.  Medical records: practicalities and principles of patient possession. , 1991, Journal of medical ethics.

[5]  J. Rethans,et al.  Do general practitioners act consistently in real practice when they meet the same patient twice? examination of intradoctor variation using standardised (simulated) patients , 1997, BMJ.

[6]  I S Kohane,et al.  Parents as direct contributors to the medical record: validation of their electronic input. , 2000, Annals of emergency medicine.

[7]  S. Toombs,et al.  The Meaning of Illness: A Phenomenological Account of the Different Perspectives of Physician and Patient , 1992 .

[8]  J H Albeck,et al.  Patient-therapist codocumentation: implications of jointly authored progress notes for psychotherapy practice, research, training, supervision, and risk management. , 1991, American journal of psychotherapy.

[9]  A Etzioni Medical records. Enhancing privacy, preserving the common good. , 1999, The Hastings Center report.

[10]  L. Gostin,et al.  Legal issues concerning electronic health information: privacy, quality, and liability. , 1999, JAMA.

[11]  E J Robinson,et al.  Improving the efficiency of patients' comprehension monitoring: a way of increasing patients' participation in general practice consultations. , 1985, Social science & medicine.

[12]  Philip Greenspun,et al.  Application of Technology: Building National Electronic Medical Record Systems via the World Wide Web , 1996, J. Am. Medical Informatics Assoc..

[13]  B. Lo,et al.  Uses and abuses of prescription drug information in pharmacy benefits management programs. , 2000, JAMA.

[14]  I S Kohane,et al.  Using the technology of the world wide web to manage clinical information , 1997, BMJ.

[15]  P S Appelbaum,et al.  Two models of implementing informed consent. , 1988, Archives of internal medicine.

[16]  L. Weed Medical records that guide and teach. , 1968, The New England journal of medicine.

[17]  I R Mackay,et al.  What happens when hospitalized patients see their own records. , 1977, Annals of internal medicine.

[18]  D W Baker,et al.  Health literacy among Medicare enrollees in a managed care organization. , 1999, JAMA.