Computerized medical records and confidentiality

There is a strong trend to computerized medical records. This method of recording information about a patient offers many advantages but also some significant disadvantages. Concerns about security, privacy and confidentiality of records are the first.

• There are problems with security and confidentiality of patient information inherent in computerized medical records. The consequences of inappropriate release of private health information can be severe, including ruined careers, public ridicule, social rejection, and economic devastation of individuals and their families. A New Jersey hospital employee, Enzima Obie, undergoing testing in anticipation of surgery received a false positive HIV test result. A second test returned a negative result, leading her physicians to conclude that the false positive was related to her recent case of malaria. A suit ensued after a lab employee reported the first test result to the employee’s supervisor. HIV test results were kept in a binder that could be viewed by any hospital employee. When Obie applied to return to work after surgery, her supervisor advised her that she would be placed on a preferred hiring list, but she was never rehired even though there were several vacancies she was qualified to fill. After a 10-day trial, the jury found the hospital violated the Aids Assistance Act and awarded $200,000 in compensatory damages.
• Computerized medical records pose new challenges to the healthcare provider’s ethical and legal obligation to safeguard confidential information and comply with the provisions of the HIPAA. The ability of individuals to access the patient’s computerized medical record from distant sites requires rigorous adherence to security measures. The placement of computer screens in a healthcare setting needs to be considered in relation to the presence of patients and visitors. Specifically, screens, and the information displayed on them, should not be visible to anyone without appropriate access to that information.

Dedicated hackers may breach the security of electronic health records, gaining access to potentially embarrassing details about an individual.

• Documentation about sexual preferences, histories of abuse, incest, mental illness, pregnancies, substance abuse, suicide attempts, HIV status and other personal medical history details may provide fodder for blackmail and other schemes. This is not a far fetched concern. A January 2003 theft of computers from an Arizona-based medical records contractor resulted in loss of the confidential and personal files of more than 500,000 members of the military, retirees, or their families. [39] Resistance to plans to computerize medical records is pervasive. Critics reacted to the plans of the Department of Health and Human Resources to implement a medical database system known as the National Health Information Network.  The plan will include the creation of electronic health records that could be shared by doctors, insurance companies, and governmental healthcare providers. Opponents of this plan took the position that electronic health records were a major violation of a patient’s privacy. Critics and others expressing concern posited that records would not only be accessible to healthcare providers without patient consent but any number of other people and organizations. These could include universities conducting research, medical students, and bureaucrats at every level, from entry-level data processors to registration clerks at medical clinics.
• Critics point out misinformation would be difficult to correct as electronic health records are shared around the medical community.
• A November 2004 Gallup poll found that a large majority of Americans did not want their medical information shared with anyone other than the doctor they shared the information without their consent: this included other doctors. Ninety-two percent opposed giving government agencies access, and 84 percent opposed giving insurance companies access without prior consent.

From Nursing Malpractice, Fourth Edition

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