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Electronic Records, Private Lives

Audits Welcome? continued...

What's to stop a hacker from breaking into one of these systems to steal personal information (such as social security numbers or other personal data)? And even if you've got a system that's harder to break into electronically than it is to get into Fort Knox with a pick and shovel, how do you know who's been looking at your private information?

"I think it's important to understand that with a paper record, you have no idea who's looking at your record," says Daniel Z. Sands, MD, MPH, professor of medicine at Harvard Medical School, and clinical systems integration architect at Beth Israel Deaconess Medical Center in Boston.

"With an electronic record, you can have an audit trail of who's looking at your record, and I think that's very important. There is certainly some risk to having electronic records, and perhaps because they're more accessible, there's more of a risk than with paper records," Sands tells WebMD.

Appropriate Access

"That being said, nobody has ever died from the inappropriate release of a medical record, but plenty of people have died because people couldn't get access to that information. I think we need to strike a balance between the security and protection of that information and the access to the information."

Many people willingly share some of their most sensitive personal information with web-based merchants, such as credit card numbers and expiration dates, bank accounts, buying preferences, addresses, phone numbers, and even social security data. Why shouldn't medical information be similarly available, as long as the patient can control access to that information?

"I meet people who are terribly afraid of all the potential," says Steven Schwaitzberg, MD, director of the Minimally Invasive Surgery Center at Tufts-New England and Associate professor of surgery at Tufts University School of Medicine in Boston. "They're very afraid of the intrusion on their privacy and demand control of the information."

He points to developments such as so-called radio frequency identification, or RFID technology, currently under development at MIT and other technology centers, in which minuscule radio-transmitting chips can be buried in everything from goods on the supermarket shelf to the clothing on your back. A similar type of technology, using retinal scans, was featured in the Stephen Spielberg sci-fi thriller Minority Report.

"RFID really could improve communication dramatically, but people are afraid of being tagged and watched and being countable," Schwaitzberg tells WebMD.

Still, he says, "millions of Americans are buying something online right now. Americans seem to be happy to give up information about themselves, and yet there is a very stalwart group of people who are very concerned."

Schwaitzberg and others who advocate online health records say many of those fears could be allayed by a well-designed system with checks and balances. For example, patients could use a personal identification number, or PIN code, to get access to an electronic medical record, sharing it with doctors or other health-care providers who need the information, and then changing the code to ensure privacy when necessary.

That way, someone who becomes injured or sick while traveling could grant instant access to health records by local doctors.

A bigger barrier to the flow of information, Schwaitzberg says, is the current hodgepodge of incompatible information systems, many of which are designed for use only in a specific hospital or group of health centers.

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