A National Database of Health Records: my first thoughts

Jerry Kennard Health Pro
  • As part of his economic revival measures, President-elect Obama wants to computerize all health records within five years. The intention is to modernize a fragmented, costly and error-prone system to one that improves quality of health and saves everyone money.


    The vision has received a broad welcome, but even its most ardent proponents are aware of the costs of implementing such a system. Perhaps of greater concern are the costs of such a system failing both in terms of its security and, more broadly, a systems failure.


    I am immediately drawn to security and privacy issues. A cursory review of news stories during 2008 reminds me that a significant gulf exists between the technology underpinning data security and the people who use it. In a year when laptops containing sensitive and private data were left on trains and in taxis, some very real concerns are bound to be aired. The logistics of putting the health care records of an entire nation into a computerized format is a mammoth undertaking.

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    So, let's think about security and privacy. Some commentators have pointed out that systems such as Google Health are not currently subject to the Health Insurance Portability and Accountability Act, the national health privacy law. But let's also reflect on the frailties of the human condition. For example, last year around 637,000 laptops were lost or stolen at US airports alone. According to a survey by the Paremon Institute, over 10,000 laptops are reported lost each week at 36 of the largest US airports and a staggering 65 percent are never reclaimed. In 2001, Eli Lilly, accidentally revealed the email addresses of 600 people who had registered for a reminder regarding fluoxetine (prozac). And so the list could continue.


    Of course not all laptops contain sensitive or private data, but many do. The vulnerability of data loss increases as it is downloaded to laptops, discs, flash-drives - whatever. But even if we allow ourselves to believe this won't happen, or will be prevented, or data won't be hacked, we're still left with the issue of privacy and data-sharing.


    Last year, Elizabeth Dove (not her real name) wrote to the magazine Computer Weekly to complain about an issue of privacy. Elizabeth lives in the UK and, like most people, is registered with the National Health Service (NHS). After contacting her family doctor about suspected depression, she learned that her computerized medical record could also be accessed by staff working in local government offices. Dove formally complained that her, "private and confidential" health records were available for staff to, "snoop, scrutinize, monitor and track". Few people in the UK, she says, realize that if they approach their doctor about an issue such as depression, their medical record may be accessible on a local government database.


    This is interesting as it points to something fairly insidious about the use and storage of data. To the NHS, the sharing of data represents an obvious and useful way of integrating and coordinating information to meet all needs of an individual. To Elizabeth Dove, "it has discriminatory undertones [that] regrettably stigmatizes people with any mental health issue."


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    A report by David Goldman, for CNNMoney.com, points to the costs of the Obama initiative at around $800 billion. It sounds expensive but as the report states, it's a drop in the bucket when compared to the $2 trillion a year the industry currently spends.


    To come to fruition a system has to be devised that thinks like a physician and is constantly and easily available. On the bright side, an estimated 212,000 jobs will be created. If it works, the system will reduce waste and will be a great deal more efficient in terms of protecting patient safety. I, for one, will be very interested to see how the development of such a system protects the rights of the individual in terms privacy and security.

Published On: January 13, 2009