Computers and Your Health Care Records
Part of the President's health care reform proposal calls for implementation of computerized database networks and "smart card" technology, which will improve record keeping and patient monitoring, as well as access to potentially life-saving information. While these technologies may prove beneficial, there are problems. Computerization of information has intensified concerns about the privacy of personal medical records. The following, adapted from a recent report by the Congressional Office of Technology Assessment, explains some essential elements of this issue.
Health care information relates to profoundly personal aspects of an individual's life. The medical records kept by physicians and hospitals about patients may include identifying information, X-ray films, EKG and lab test results, daily observations by nurses, physical examination results, diagnoses, drug and treatment orders, progress notes and post-operative reports from physicians, medical histories secured from patients, consent forms authorizing treatment or the release of information, summaries from the medical records of other institutions, and copies of forms shared with outside institutions for insurance purposes.
In addition, medical records may also contain subjective information based on impressions and assessments by the health care worker. Medical records may include impressions of mental abilities and psychological stability and status; lifestyle information or suppositions (including sexual practices and functioning); dietary habits, exercise, and recreational activities (including dangerous ones life insurers would want to know about); religious observances and their impact on treatment decisions; alcohol and drug use; and comments on attitudes toward illness, physicians, treatments, compliance with therapy and advice, etc.
Increasingly sophisticated diagnostic tools yield more and more detailed, and potentially sensitive, information about a person's body - genetic research and testing result in information that not only indicates a patient's present condition but also enables prediction of his or her future medical condition and the prospect of developing specific medical problems.
Medical information can affect such basic life activities as getting married, securing employment, obtaining insurance, or driving a car. Medical conditions have served as the basis for discriminatory practices, making it difficult to participate in these activities. Because of its highly sensitive nature, improper disclosure of medical information can result in loss of business opportunities, compromised financial status, damaged reputation, harassment, and personal humiliation. However, defining what is "sensitive" in a record may be difficult, since the definitions may depend on the intended use of a record. Yet at the same time, the integrity of the patient record and the disclosure by the patient to the physician of information necessary to establish an accurate diagnosis is desirable to attain the best clinical outcome. Simply stated, disclosure of medical information by the patient, free of the fear of improper use, is necessary to obtaining good quality medical care. An environment must be maintained in which this kind of disclosure is possible. In its testimony to the U.S. Privacy Commission, the American Medical Association stated, "Patients would be reluctant to tell their physicians certain types of information, which they need to know in order to render appropriate care, if patients did not feel that such information would remain confidential." More recently, the AMA Code of Medical Ethics stated:
"The confidentiality of physician-patient communications is desirable to assure free and open disclosure by the patient to the physician of all information needed to establish a proper diagnosis and attain the most desirable clinical outcome possible. Protecting the confidentiality of the personal and medical information in such medical records also necessary to prevent humiliation, embarrassment, or discomfort of patients. …