The privacy implications of the use of medical history smart cards are obvious. Among such concerns for doctors are the ability of patients to access information on their cards which may distress them, and the use of such cards to transfer the personal health data of patients to central data banks such as the Health Insurance Commission. The advent of medical history smart cards will require reworking, and extensions to, the Commonwealth Privacy Act 1988 to allay some such fears. The Federal Privacy Commissioner has called for the latter Act to be reworked as a means of protecting the privacy of an individual's personal information and in December 1995 he published an information paper titled "'Smart Cards: Implications for Privacy'".24,25
One of the serious drawbacks of utilising fax machines in medical practice is their lack of privacy. When messages are printed out on the receiving end the sender loses control over who has access to them. Confidential reports and requests are accessible to anyone who walks by the fax machine. This can be circumvented by the use of a 'mailbox' which allows a confidential message to be stored electronically in the receiving fax machine's memory until an assigned password is entered. It is easy to become careless with faxed information. Although covering transmission sheets may seem like a waste of time and paper, they are in fact essential to good records of faxed information. When staff do not complete them, there is no indication of the date, time, and the person making the fax transmission. In litigation in which time may be an important factor, the absence of such detail could be critical.
Problems can arise when faxed transmissions are mislaid in the doctor's rooms. Staff may assume that a doctor has read a fax and simply file the document as they do mail, unless there is some procedure to confirm that the doctor has seen and acted upon the faxed information. The latter may be a dangerous assumption. Failure to act upon faxed information resulting in foreseeable harm or injury to a patient may constitute negligence. The disadvantage of the impermanence of the photosensitive fax copy paper used in the older machines has been overcome by the development of the newer plain paper fax machines.
Doctors should not assume that anything sent by fax is 'legal'. Prescriptions for controlled drugs, some certificates and other documentation are not acceptable in a fax format. The requirements set forth in legislation and regulations should be followed.
McInerney v MacDonald ([ 1992] 93 DLR [4th] 415) per La Forest J.
Medico-legal issues in clinical practice No. 1. London: The Medical Defence Union, 1986.