Privacy and Security for Electronic Health Records: The Ramifications of "Interoperability"

Article excerpt

It is refreshing to see bipartisan support for something in these rancorous times in Washington. One such issue is health information technology, subject of ten pieces of proposed legislation in 2005. In our enthusiasm over this technology, however, we need to be sure that patients' control over their health information is an integral part of reform.

One of the most prominent proposals is the Health Technology to Enhance Quality bill (S. 1262), introduced in June by senators Bill Frist and Hillary Clinton. The bill aims "to reduce healthcare costs, improve efficiency, and improve healthcare quality through the development of a nation-wide interoperable health information technology system." The key concept here is "interoperability," defined in 2005 by the Health Information and Management Systems Society as "the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities." One of the main goals is an infrastructure that permits the electronic exchange of health information. In essence, the bill aims to make it as easy and secure to transmit health information electronically as it is to execute ATM transactions.

Electronic records have many virtues. In the wake of Hurricane Katrina, the Veterans Health Administration (where I work) was able to back up all electronic records for 50,000 patients from the flooded New Orleans VA Medical Center and nearby veterans' outpatient clinics and re-enter them into a computer in Houston within four days of the storm. Also following the hurricane, the federal Office of the National Coordinator for Health Information Technology was able to work with pharmacies to organize a centralized database so that prescription drug records for 800,000 people affected by the storm would be available to health care providers. On a day-to-day basis, electronic records allow caregivers to make a patient's complete medical history instantly available to other health care providers, to highlight information that might get buried in a paper chart, and to more easily identify and prevent adverse drug interactions by cross-tracking a patient's prescriptions. …

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