Health Privacy Background

[Robert Gellman <rgellman@cais.cais.com>]

There have been some net postings about newly proposed
legislation to protect the privacy of health records.  Some of
the postings show a lack of understanding of the current
situation for health records.  These records are largely
unprotected by law, and there are few barriers to use and
disclosure.

This situation has been recognized for almost twenty years.  In
fact, virtually every study of health record confidentiality has
reached similar conclusions and offered similar recommendations.

In order to help educate those who are interested in this
subject, I intend to post excerpts from some of these studies
over the next few days.  You may like or hate the current
proposals, but there is no dispute that they would significantly
increase protection for health records.  There can be no dispute
that things will continue to get worse in the absence of new
legislation.  

     From the 1977 report of the Privacy Protection Study
Commission:

          First, medical records now contain more
     information and are available to more users than ever
     before.

          Second, the control medical care providers once
     exercised over information in medical records has been
     greatly diluted as a consequence of specialization
     within the medical profession, population mobility,
     third-party demands for medical-record information, and
     the increasing incidence of malpractice suits.

          Third, the comparative insulation of medical
     records from collateral uses, normal even a decade ago,
     cannot be entirely restored.  Indeed, it appears that
     the importance of medical-record information to those
     outside of the medical-care relationship, and their
     demands for access to it, will continue to grow. 
     Moreover, owing to the rising demand for access by
     third parties, coupled with the expense of limiting
     disclosure to that which is specifically requested by
     the non-medical user, there appears to be no natural
     limit to the potential uses of medical-record
     information for purposes quite different from those for
     which it was originally collected.

          Fourth, as third parties press their demands for
     access to medical-record information, the concept of
     consent to its disclosure . . .  has less and less
     meaning. 

Comment:  These conclusions are still valid today and, if
anything, the situation has gotten worse.  There are more third
parties who obtain and use identifiable health records today than
fifteen years ago.  The longer we wait to pass legislation, the
worse things will get in the future.



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+   Robert Gellman          rgellman@cais.com   +
+   Privacy and Information Policy Consultant   +
+   431 Fifth Street S.E.                       +    
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