[Med-privacy] Br Jnl HC&IM: Brits Realize the Need for Privacy of Sensitive Health Records

[DPeelMD@aol.com]

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The British Journal of=20
Healthcare Computing &
Information Management

Abstract
April 2004=20
Volume 21 Number 3
Who do we trust?
The price of freedom is eternal vigilance: and our four articles illustrate=20
both the truth of this aphorism and the difficulties encountered in the purs=
uit=20
of it. Of course, it had to come. Long gone are the days when a=20
confidentiality policy for a large acute hospital realtime system could be b=
ased on the=20
assumption that it should be no less secure than the existing manual system.=
 The=20
dangers that might ensue, as technology and changing social attitudes made=20
improper access to confidential records increasingly possible, are no longer=
=20
theoretical. Those dangers are now very real. As the concepts embodied in=20
Information for health, The NHS plan, and the National Programme for IT move=
 slowly=20
towards fruition, so also comes the day when interoperability and=20
interaccessibility across healthcare and socialcare records becomes a realit=
y. How can we be=20
certain that the information contained in those records is secure, and safe=20
to use?
Three of our articles describe measures designed to give us that assurance.=20
In her article, Dr Janine Brooks, the Caldicott Guardian for the NHS=20
Information Authority, explains the vital role that guardians have to perfor=
m across=20
both healthcare and socialcare in ensuring only the proper use of patients=
=E2=80=99=20
information, and the objective of the new UK Council of Caldicott Guardians=20=
to=20
ensure clear guidance and uniform application of that guidance across the co=
untry.=20
In their article, Damian Mitchell, NHSU, and Mark Johnson of Niche Healthcar=
e=20
Consulting describe the need to achieve proper awareness of the=20
confidentiality of prisoners=E2=80=99 medical records, and the measures take=
n recently to bring=20
that about. And in his article, Benedict Stanberry, a lawyer with a special=20
interest in information governance in healthcare, points out how keeping pat=
ients=E2=80=99=20
medical records private has not only been rebranded but also redefined in th=
e=20
most recent update of the NHS=E2=80=99s Confidentiality Code of Practice.
Our fourth article looks at another side of the coin: the public=E2=80=99s c=
onfidence=20
in the NHS=E2=80=99s ability to keep their medical records private and confi=
dential.=20
Barry Barber, Director of Health Data Protection Ltd, reviews the issues tha=
t=20
surround and, which in many cases might well threaten, both safety and=20
confidentiality as integrated systems become ever nearer. Of particular note=
 are=20
those many elements of legislation, which either singly or in combination, c=
ould=20
erode our earlier concepts of medical confidentiality.
The old and the new points of view are in no way opposed. Both represent a=20
profound belief in the need to ensure that the information in patients=E2=
=80=99 and=20
clients=E2=80=99 records should be safe to use so far as treatment is concer=
ned, and that=20
they should be available only to those properly concerned with that treatmen=
t.=20
It is, of course, at this point that the argument becomes difficult. Are=20
there not wider considerations that should be taken into account, that would=
 allow=20
access to records =E2=80=94 appropriately anonymised =E2=80=94 in order to f=
urther studies=20
in epidemiology (cancer registries are a case in point), or other aspects of=
=20
public health (vaccination rates, for example)? Most would agree that such=20
access can only be beneficial. But are there other, wider, considerations th=
at=20
should also be taken into account =E2=80=94 access, not just to collective a=
nonymous data,=20
but to personal individual data? And what might such considerations be?
The national interest is one that springs to mind, and it is at that point=20
that the vital question of trust emerges. Even within government, never mind=
=20
public opinion, views on the national interest differ. One has but to recall=
 the=20
Matrix Churchill affair when Customs officials pursued the law, whilst the=20
Foreign Office pursued what was considered to be the wider national interest=
. In=20
the recent Gunn case, the Crown Prosecution Service attempted a prosecution=20
under the Official Secrets Act, which was then held to be inadvisable. In=20
circumstances such as these, one can uncomfortably foresee a circumstance wh=
en a=20
Caldicott guardian, pursuing nationally agreed guidance, encounters percepti=
ons=20
of the wider national interest that negate that guidance. It all comes down=20=
to=20
trust. If there is public trust in those who at the time determine what is t=
he=20
national interest, such problems might not arise. But if that trust is=20
eroded, and at a time when many consider the independence of the judiciary a=
nd even=20
the constitution to be gravely under threat, then every move that might be=20
deemed to attack the confidentiality of personal healthcare information must=
 be=20
viewed with the greatest care. Jefferson was right: the price of freedom is=20
indeed eternal vigilance.
 Michael Fairey

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<H1><IMG height=3D110 alt=3D"The British Journal of Healthcare Computing &am=
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<H2><BR><B>The British Journal of <BR>Healthcare Computing &amp;<BR>Informat=
ion Management</B></H2></TD></TR></TBODY></TABLE></DIV>
<DIV><B><FONT size=3D4>Abstract</FONT></B></DIV>
<DIV><FONT size=3D4><B>April 2004 <BR></B>Volume 21 Number 3</FONT></DIV>
<DIV>
<DIV>
<H2 align=3Dcenter>Who do we trust?</H2>
<P>The price of freedom is eternal vigilance: and our four articles illustra=
te both the truth of this aphorism and the difficulties encountered in the p=
ursuit of it. Of course, it had to come. Long gone are the days when a confi=
dentiality policy for a large acute hospital realtime system could be based=20=
on the assumption that it should be no less secure than the existing manual=20=
system. The dangers that might ensue, as technology and changing social atti=
tudes made improper access to confidential records increasingly possible, ar=
e no longer theoretical. Those dangers are now very real. As the concepts em=
bodied in <I>Information for health, The NHS plan, </I>and the National Prog=
ramme for IT move slowly towards fruition, so also comes the day when intero=
perability and interaccessibility across healthcare and socialcare records b=
ecomes a reality. How can we be certain that the information contained in th=
ose records is secure, and safe to use?</P>
<P>Three of our articles describe measures designed to give us that assuranc=
e. In her article, Dr Janine Brooks, the Caldicott Guardian for the NHS Info=
rmation Authority, explains the vital role that guardians have to perform ac=
ross both healthcare and socialcare in ensuring only the proper use of patie=
nts=E2=80=99 information, and the objective of the new UK Council of Caldico=
tt Guardians to ensure clear guidance and uniform application of that guidan=
ce across the country. In their article, Damian Mitchell, NHSU, and Mark Joh=
nson of Niche Healthcare Consulting describe the need to achieve proper awar=
eness of the confidentiality of prisoners=E2=80=99 medical records, and the=20=
measures taken recently to bring that about. And in his article, Benedict St=
anberry, a lawyer with a special interest in information governance in healt=
hcare, points out how keeping patients=E2=80=99 medical records private has=20=
not only been rebranded but also redefined in the most recent update of the=20=
NHS=E2=80=99s <I>Confidentiality Code of Practice</I>.</P>
<P>Our fourth article looks at another side of the coin: the public=E2=80=
=99s confidence in the NHS=E2=80=99s ability to keep their medical records p=
rivate and confidential. Barry Barber, Director of Health Data Protection Lt=
d, reviews the issues that surround and, which in many cases might well thre=
aten, both safety and confidentiality as integrated systems become ever near=
er. Of particular note are those many elements of legislation, which either=20=
singly or in combination, could erode our earlier concepts of medical confid=
entiality.</P>
<P>The old and the new points of view are in no way opposed. Both represent=20=
a profound belief in the need to ensure that the information in patients=E2=
=80=99 and clients=E2=80=99 records should be safe to use so far as treatmen=
t is concerned, and that they should be available only to those properly con=
cerned with that treatment. It is, of course, at this point that the argumen=
t becomes difficult. Are there not wider considerations that should be taken=
 into account, that would allow access to records =E2=80=94 appropriately an=
onymised =E2=80=94 in order to further studies in epidemiology (cancer regis=
tries are a case in point), or other aspects of public health (vaccination r=
ates, for example)? Most would agree that such access can only be beneficial=
. But are there other, wider, considerations that should also be taken into=20=
account =E2=80=94 access, not just to collective anonymous data, but to pers=
onal individual data? And what might such considerations be?</P>
<P>The national interest is one that springs to mind, and it is at that poin=
t that the vital question of trust emerges. Even within government, never mi=
nd public opinion, views on the national interest differ. One has but to rec=
all the Matrix Churchill affair when Customs officials pursued the law, whil=
st the Foreign Office pursued what was considered to be the wider national i=
nterest. In the recent Gunn case, the Crown Prosecution Service attempted a=20=
prosecution under the Official Secrets Act, which was then held to be inadvi=
sable. In circumstances such as these, one can uncomfortably foresee a circu=
mstance when a Caldicott guardian, pursuing nationally agreed guidance, enco=
unters perceptions of the wider national interest that negate that guidance.=
 It all comes down to trust. If there is public trust in those who at the ti=
me determine what is the national interest, such problems might not arise. B=
ut if that trust is eroded, and at a time when many consider the independenc=
e of the judiciary and even the constitution to be gravely under threat, the=
n every move that might be deemed to attack the confidentiality of personal=20=
healthcare information must be viewed with the greatest care. Jefferson was=20=
right: the price of freedom is indeed eternal vigilance.</P>
<P>&nbsp;<B>Michael Fairey</B></P></DIV></DIV></BODY></HTML>

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