[Med-privacy] Dallas Morning News: Medical Privacy in a digital era
dpeelmd@aol.com
dpeelmd@aol.com
Wed, 22 Nov 2006 20:23:33 -0500
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Dallas Morning News
Dallasnews.com
http://www.dallasnews.com/sharedcontent/dws/bus/columnists/jlanders/stories/=
DN-landers_21bus.ART0.State.Edition1.31b54cb.html#=20
BUSINESS=20
Columnist:=20
Jim Landers=20
=20
=20
Medical privacy in a digital era
The push to electronic records could put patient data at risk=20
12:00 AM CST on Tuesday, November 21, 2006
Digitizing medical records could save scores of billions, even hundreds of b=
illions of dollars. The downside is, it costs tens of billions to get starte=
d.=20
=20
There's also a dark side to electronic medical records: the threat to privac=
y.=20
=20
"Health records are the most sensitive data on Earth about you," said Dr. De=
borah Peel, an Austin psychiatrist. "And every sort of entity is lined up, w=
aiting to get their hands on this data, because they all feel they have some=
kind of worthy use for it."=20
=20
Dr. Peel heads Patient Privacy Rights, an organization trying to get laws pa=
ssed giving patients control over any sharing of their medical information.=20=
There are privacy protections already in federal and state laws, but Dr. Pee=
l argues they are inadequate against the challenge of digitized information.=
=20
=20
"People think electronic data is somehow free, that if you process it, you t=
hink it's yours, too. No one would ever have those thoughts about paper reco=
rds," she said.=20
=20
Insurance companies, which have great stores of information about patients,=20=
argue they protect those records while mining them for anonymous information=
that can spot useful =E2=80=93 or wasteful =E2=80=93trends in therapy.=20
=20
In August, the BlueCross and BlueShield companies announced they would data-=
mine the records of 79 million patients and make the results available to co=
rporate customers. Eventually, the information could also be used to provide=
quality and price information to consumers about medical care.=20
=20
"We are going to come up with more cost-effective ways of treatment," said D=
r. Paul Handel, chief medical officer of BlueCross BlueShield of Texas.=20
=20
Dr. Handel said all patient data would be stripped of identifying informatio=
n. Mental health information would not be included in the database, he said.=
=20
=20
Dr. Peel said many patients seeking a psychiatrist or psychologist won't eve=
n go through their health insurer because of fears that a claim would get ba=
ck to their employer and ruin chances of advancement or even employment.=20
"It used to be safe to keep notes," she said. "Now the standard for psychoan=
alysis is no notes."=20
=20
While European nations are well ahead of the United States in introducing el=
ectronic medical records, privacy concerns have slowed the process there as=20=
well.=20
=20
Austrians get health care using a plastic card with an embedded microprocess=
or that contains basic information about them but no photo, fingerprint or a=
ny other biometric identifier.=20
=20
They can participate in a pilot program that includes their prescription his=
tory on these smart cards, but only if they sign up voluntarily.=20
=20
"There is a fear in society of possible abuse of this data. We need a consum=
er education campaign to win public acceptance," said Christoph H=C3=B6rhan,=
spokesman for the Austrian Health Ministry. "It will actually be safer than=
it is now. With paper files, it's unclear who is looking at them."=20
=20
Austria is contemplating an electronic medical record where anyone who looks=
at the data has to use a fingerprint to prove authorization. That identifie=
r would be kept with the record as an audit trail for who viewed the informa=
tion.=20
=20
Taiwan uses electronic medical records in which the entire file is kept on a=
microprocessor embedded in a smart card.=20
=20
Germany's approach limits the smart card to identification data and an encry=
pted key.=20
=20
To get access to the electronic medical record, which is kept on a large, pr=
ivate network database, a doctor or pharmacist must use both the patient's c=
ard and his own card. It's a two-key system, similar to what banks use for s=
afe deposit boxes.=20
Data-mining is one way that proponents of electronic medical records say the=
y will deliver on cost-saving promises. They could offer a way to test the e=
ffectiveness of medicines, for example, that would be independent of any tes=
ting done by drug manufacturers.=20
=20
"A legitimate approach like that would be transformative," Dr. Peel said. "W=
e don't have any longitudinal studies, 15 years of use for anti-depressants=20=
or anti-psychotics. ... Legitimate data gathering over large populations is=20=
an incredible promise and will transform our understanding of diseases and o=
ur ability to treat patents."=20
=20
First, however, Dr. Peel wants federal legislation requiring informed, prior=
consent from patients before information can be shared =E2=80=93 and an aud=
it trail similar to what the Austrians are planning.=20
=20
E-mail jlanders@dallasnews.com
=20
Check out the new AOL. Most comprehensive set of free safety and security to=
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________________________________________________________________________
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Jim <SPAN class=3Dcorrection id=3D"">Landers</SPAN> </SPAN></FONT></B></H3><=
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<H2><SPAN class=3Dvitstoryheadline><B><FONT face=3D"Times New Roman"><SPAN s=
tyle=3D"FONT-SIZE: 18pt"><FONT size=3D6>Medical privacy in a digital era</FO=
NT></SPAN></FONT></B></SPAN></H2>
<div class=3DMsoNormal><SPAN class=3Dvitstorydeck><FONT face=3D"Times New Ro=
man" size=3D4><SPAN style=3D"FONT-SIZE: 13.5pt"><FONT size=3D5>The push to e=
lectronic records could put patient data at risk</FONT> </SPAN></FONT></SPAN=
><SPAN class=3Dvitstorybody></SPAN></div>
<H5><SPAN class=3Dvitstorydate><B><FONT face=3D"Times New Roman" size=3D2><S=
PAN style=3D"FONT-SIZE: 10pt">12:00 AM CST on Tuesday, November 21, 2006</SP=
AN></FONT></B></SPAN></H5>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Digitizing medical records could save scores of billions, eve=
n hundreds of billions of dollars. The downside is, it costs tens of billion=
s to get started. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">There's also a dark side to electronic medical records: the t=
hreat to privacy. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">"Health records are the most sensitive data on Earth about yo=
u," said Dr. Deborah Peel, an Austin psychiatrist. "And every sort of entity=
is lined up, waiting to get their hands on this data, because they all feel=
they have some kind of worthy use for it." </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Dr. Peel heads Patient Privacy Rights, an organization trying=
to get laws passed giving patients control over any sharing of their medica=
l information. There are privacy protections already in federal and state la=
ws, but Dr. Peel argues they are inadequate against the challenge of digitiz=
ed information. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">"People think electronic data is somehow free, that if you pr=
ocess it, you think it's yours, too. No one would ever have those thoughts a=
bout paper records," she said. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Insurance companies, which have great stores of information a=
bout patients, argue they protect those records while mining them for anonym=
ous information that can spot useful =E2=80=93 or wasteful =E2=80=93trends i=
n therapy. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">In August, the <SPAN class=3Dcorrection id=3D"">BlueCross</SP=
AN> and <SPAN class=3Dcorrection id=3D"">BlueShield</SPAN> companies announc=
ed they would data-mine the records of 79 million patients and make the resu=
lts available to corporate customers. Eventually, the information could also=
be used to provide quality and price information to consumers about medical=
care. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">"We are going to come up with more cost-effective ways of tre=
atment," said Dr. Paul Handel, chief medical officer of <SPAN class=3Dcorrec=
tion id=3D"">BlueCross</SPAN> <SPAN class=3Dcorrection id=3D"">BlueShield</S=
PAN> of Texas. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Dr. Handel said all patient data would be stripped of identif=
ying information. Mental health information would not be included in the dat=
abase, he said. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT size=3D3><SPAN style=3D"FONT-SIZE: 12pt"><FONT face=3D"Times New=20=
Roman, Times, serif">Dr. Peel said many patients seeking a psychiatrist or p=
sychologist won't even go through their health insurer because of fears that=
a claim would get back to their employer and ruin chances of advancement or=
even employment. </FONT></SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">"It used to be safe to keep notes," she said. "Now the standa=
rd for psychoanalysis is no notes." </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">While European nations are well ahead of the United States in=
introducing electronic medical records, privacy concerns have slowed the pr=
ocess there as well. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"><SPAN class=3Dcorrection id=3D"">Austrians</SPAN> get health=20=
care using a plastic card with an embedded microprocessor that contains basi=
c information about them but no photo, fingerprint or any other biometric id=
entifier. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">They can participate in a pilot program that includes their p=
rescription history on these smart cards, but only if they sign up voluntari=
ly. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">"There is a fear in society of possible abuse of this data. W=
e need a consumer education campaign to win public acceptance," said <SPAN c=
lass=3Dcorrection id=3D"">Christoph</SPAN> H=C3=B6rhan, spokesman for the Au=
strian Health Ministry. "It will actually be safer than it is now. With pape=
r files, it's unclear who is looking at them." </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif"><FONT size=3D3><SPAN style=
=3D"FONT-SIZE: 12pt">Austria</SPAN></FONT> <FONT size=3D3>is contemplating a=
n electronic medical record where anyone who looks at the data has to use a=20=
fingerprint to prove authorization. That identifier would be kept with the r=
ecord as an audit trail for who viewed the information. </FONT></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif"></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif"><FONT size=3D3><SPAN style=
=3D"FONT-SIZE: 12pt">Taiwan</SPAN></FONT> <FONT size=3D3>uses electronic med=
ical records in which the entire file is kept on a microprocessor embedded i=
n a smart card.</FONT> </FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif"></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif"><FONT size=3D3><SPAN style=
=3D"FONT-SIZE: 12pt">Germany</SPAN></FONT>'s <FONT size=3D3>approach limits=20=
the smart card to identification data and an encrypted key.</FONT> </FONT></=
div>
<div><FONT face=3D"Times New Roman, Times, serif"></FONT> </div>
<div><FONT size=3D3><SPAN style=3D"FONT-SIZE: 12pt"><FONT face=3D"Times New=20=
Roman, Times, serif">To get access to the electronic medical record, which i=
s kept on a large, private network database, a doctor or pharmacist must use=
both the patient's card and his own card. It's a two-key system, similar to=
what banks use for safe deposit boxes. </FONT></SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">Data-mining is one way that proponents of electronic medical=20=
records say they will deliver on cost-saving promises. They could offer a wa=
y to test the effectiveness of medicines, for example, that would be indepen=
dent of any testing done by drug manufacturers. </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt">"A legitimate approach like that would be <SPAN class=3Dcorre=
ction id=3D"">transformative</SPAN>," Dr. Peel said. "We don't have any long=
itudinal studies, 15 years of use for anti-depressants or <SPAN class=3Dcorr=
ection id=3D"">anti-psychotics</SPAN>. ... Legitimate data gathering over la=
rge populations is an incredible promise and will transform our understandin=
g of diseases and our ability to treat patents." </SPAN></FONT></div>
<div><FONT face=3D"Times New Roman, Times, serif" size=3D3><SPAN style=3D"FO=
NT-SIZE: 12pt"></SPAN></FONT> </div>
<div><FONT size=3D3><SPAN style=3D"FONT-SIZE: 12pt"><FONT face=3D"Times New=20=
Roman, Times, serif">First, however, Dr. Peel wants federal legislation requ=
iring informed, prior consent from patients before information can be shared=
=E2=80=93 and an audit trail similar to what the <SPAN class=3Dcorrection i=
d=3D"">Austrians</SPAN> are planning. </FONT></SPAN></FONT></div>
<div><FONT size=3D3><SPAN style=3D"FONT-SIZE: 12pt"><FONT face=3D"Times New=20=
Roman, Times, serif"></FONT></SPAN></FONT> </div>
<div><FONT size=3D3><SPAN style=3D"FONT-SIZE: 12pt"><FONT face=3D"Times New=20=
Roman, Times, serif">E-mail </FONT><A title=3Dmailto:jlanders@dallasnews.com=
href=3D"javascript:parent.ComposeTo('jlanders@dallasnews.com', '');"><FONT=20=
face=3D"Times New Roman, Times, serif">jlanders@dallasnews.com</FONT></A></S=
PAN></FONT></div>
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