h informationCriterion A: Describing the issue
The misuse of private health care information can cause discrimination against others in society. Nowadays we trust and depend upon the medical professionals to secure our private records. The computer revolution has made the process of transmitting information convenient, thus allowing our family secrets to travel from our family doctor to hospitals to insurance companies – increasing the level of insecurity. The idea of federal security legislation has been effective, but in these times other solutions are also needed to secure information so that the patient can be comfortable with the format at which the information is controlled. Without safeguards to assure that obtaining health care will not endanger our privacy, public discrimination can be created. The confidentiality of health information is an issue that profoundly affects every American. The fundamental question maintains Secretary of Health and Human Services Donna Shalala, is: “Will our health records be used to heal the public or reveal the patients?” 1
Criterion B: IT background of the issue
In the past medical records were stored by means of big filing cabinets that were physically locked in the doctors office. The safety of any disclosure was limited to the number of people who owned a key. The future has brought new technology in the computer and software industries where electronic databases were developed in order to control, store and arrange medical records more sufficiently and conveniently for authorized users. Hereby medical institutions had the ability to store vast amounts of information that can be accessed easily and allowed them to transfer the medical records via networks (email) to one another. Today one persons health information can be found in insurance companies, hospitals, therapists and psychiatrists all over the United States where multiple users within each company have the ability to access the information. Networks have made it possible for people to attach information by email and to copy2 medical records easily. Today, crackers can get remote access through any computer and obtain personal health records.
Criterion C: Analyzing the impact of the issue
Private health records can reflect unfavorably on individuals. In Florida for example, the names of 4,000 HIV-positive patients were carelessly released to two newspapers 4. It has been stated that this act has influenced the HIV-positive patients of finding jobs. The confidentiality issue has become so serious that President Clinton went before the nation late in 1999 with a speech calling for legislation to protect patient privacy 3. On the other hand it can inform the public not have to have any sexual activity with these HIV -positive patients, therefore decreasing the chance of obtaining the virus.
Federal laws in the United States falls short of delivering consistent, comprehensive protection of the privacy of health information nationwide. An example of inconsistency is the uprising of another issue namely the reliability of correct health information of each citizen. There is no mechanism for the patients to view their medical records and check if the information is correct. Accuracy is a huge issue .For example, the Massachusetts-based Medical Information Bureau, a clearinghouse for about 750 insurers, has acknowledged that as many as 3.5% of its approximately 15,000,000 individual files contain inaccurate data. Because the information relates to life expectancy–blood pressure, weight, and cholesterol level–and is used by the insurers for underwriting purposes, inaccuracies may result in a decision to deny coverage or charge higher rates 5. Another related issue is that employers have no reason to inform present or prospective patients when medical information is used in making employment decisions. Because most companies are self-insured and, therefore, have access to patients prescription and other health records, unreliable data may have serious consequences 6. When an incorrect medical record is disclosed to the public, unnecessary discrimination to the person could be created. The level of acceptance of the person in the society could decrease having severe consequences.
Criterion D: Solutions to Problems arising from the issue
The two key solutions to the problem can be solved using a technical implementation and specific law enforcement.
Medical records are transferred all over the United States and we cannot specify its location. Authorities should impose a law, which states that each health-orientated institute should contain system software, which records dates, time, and address of destinations with its sender. This process will keep track of what the medical record is used for. The software should have the ability to identify each authorized user within each health-orientated institute and record a date, time and place when the user edits or removes (by means of copying or printing) a medical record from its database. The software will disable remote access to any database and will inform users if any hacking is attempted. The proposed system will also include a way where a patient can control his/her medical information in order to see if it is correct. If the patient makes any necessary changes it will notify each medical institute in the form of an automatic e-mail.
The second solution consists entirely of laws that need to be obeyed by each citizen. They can be based on five basic principles:
Boundries: Patients medical information must only be used for his/her health treatment. The medical record is not allowed to be transferred to any health institute if the patient has not approved this action by means of a signature. Medical information can only be disclosed if the patient is a danger to himself and any other members of society (exception).
Security: Health institutes should have advanced security measures in order to keep medical records secretive and secure from any unauthorized users.
Consumer controls: Patients should be able to access their information via networks (Internet) or at any medical institute in order to check, edit or update his/her record. The particular medical institutes must inform them when medical records needs to be transferred so that they can now what is done to their medical records.
Accountability: The people who misuses health information by means of revealing the information to the public will act in a court of law and will receive severe punishment for their actions.
Public responsibility: The public has to be entirely sure that health institutions are securing their health information to the fullest extent so that no discriminations can enclose on them.
The two solutions can be categorized as ethical and non-ethical approaches to the problem. The limitations involved in the first solution are greater than that of the second solution making it less feasible. The first solution is expensive and time consuming. The second solution is more effective since as for in the past citizens have obeyed many laws due to severe punishment that could be forced upon them. The second solution will still hold uncertainties, but will be more successful since the limitations involved are minuscule.
Criterion E: Selecting and using sources
National Committee on Vital and Health Statistics. Subcommittee on Privacy and Confidentiality. 21 Aug. 2001 <http://www.os.dhhs.gov/>.
The Committee on Labor and Human Resources and the Committee on Finance of the Senate. CONFIDENTIALITY OF INDIVIDUALLY-IDENTIFIABLE HEALTH INFORMATION. 11 Sept. 1997 <http://aspe.os.dhhs.gov/>.
How Private Is My Medical Information? Privacy Rights Clearinghouse. 3 Mar. 2000 <http://www.privacyrights.org>.
Medical Records, Privacy & Confidentiality. 3 Mar. 1997 <http://www.netreach.net/>.
Privacy and Confidentiality. 30 July 1999 <http://www.nursingworld.org/>.
Wired magazine. Shared Files: Real or Mirage? 14 Sept. 2001 <http://www.wired.com/>.
Confidentiality of individuals. 15 Aug. 1997 <http://www.findarticles.com/>.
1. The Committee on Labor and Human Resources and the Committee on Finance of the Senate. CONFIDENTIALITY OF INDIVIDUALLY-IDENTIFIABLE HEALTH INFORMATION. 11 Sept. 1997 <http://aspe.os.dhhs.gov/>.
2,Copy in the form of printing and writing information down physically or secondary storing
3,4.Confidentiality of individuals. 15 Aug. 1997 <http://www.findarticles.com/>.
5.Medical Records, Privacy & Confidentiality. 3 Mar. 1997 <http://www.netreach.net/>.