AMA editorial

[peter marshall <techdiff@ix.netcom.com>]

http://www.ama-assn.org/sci-pubs/amnews/amn_99/edi
t0809.htm

    [American Medical News]

Editorial for Aug. 9, 1999
Patient records confidentiality: Identity crisis

 The deadline is fast approaching for Congress to put in
>place comprehensive legislation to preserve the
>confidentiality of medical records. When it passed the
>Health Insurance Portability and Accountability Act in
>1996, Congress included a mandate that privacy
>legislation be enacted by Aug. 21, 1999, or the decision
>will revert to the Health and Human Services
>Administration. At this writing, congressional consensus
>seems to be lacking.
>                 As they grapple with this important issue, our nation's policymakers would be well advised to give serious consideration to a comprehensive AMA report approved by delegates at this June's Annual Meeting. Prepared by a blue- ribbon Inter-Council Task Force on Privacy and Confidentiality, the report provides straightforward guidance on two key facets: appropriate uses of personal health information and the development of unique patient identifiers.
> 
>                 The report notes that there are many appropriate uses of
>                 personally identifiable health information, including
>                 quality assurance and improvement activities, risk
>                 management, utilization review, credentialing and peer
>                 review. However, no organization has the "right" to such
>                 information. The AMA's baseline policy is that informed
>                 consent should be obtained before such information is
>                 used.
> 
>                 When this is not possible, the AMA offers two
>                 alternatives: Identifying information should be stripped
>                 from the medical record or an objective, publicly
>                 accountable review board must conclude, after weighing
>                 risks and benefits, that patient consent is not needed.
>                 In the research area, the institutional review board
>               mechanism is filling this role, and the AMA spells out
>                 guidelines under which it might be appropriate for a
>                 researcher to use personally identifiable information
>                 without patient consent.
> 
>                 Further, the AMA recommends that for research projects
>                 falling outside an IRB purview -- as well as for
>                 operational uses of personally identifiable health
>                 information -- local confidentiality assurance boards
>                 should be in place, and should be held to the same
>                 standards as are IRBs. Under no circumstances is the use
>                 of personally identifiable health information for
>                 commercial applications appropriate.
> 
>                 The task force also notes that the 1996 legislation calls
>                 for establishment of a unique patient identifier for
>                 every individual, health plan, physician or other
>                 provider and employer. The AMA opposes such a step,
>                 absent the development of totally secure technology that
>                 would prevent linkage of various clinical records from
>                 different care settings and times, across institutional
>                 boundaries, to other personal information. At present, a
>                 unique patient identifier would allow linking of an
>                 individual's health information with financial data,
>                 purchasing habits and family information; the
>                 consequences might be social, financial or job
>                 discrimination and loss of privacy.
> 
>                 Establishing a coherent national policy on patient
>                 privacy will not be an easy task. Clearly, some uses of
>                 patient information can contribute significantly to
>                 advances in health care and patient management. These
>                 valid uses, however, must be carefully balanced against
>                 any incursions into information about patients that could
>                 adversely affect individuals or groups. The
>                 recommendations of the AMA Task Force spell out a
>                 rational approach that should serve as a model for
>                 policymakers.