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Electronic Medical Records, Security, and Your Responsibility
We all know that medical records will be moving into the electronic realm. This isn’t specific to medical records; it could be restated as “all data will be moving into the electronic realm.” There are many advantages to this migration: Data can be munched up, parsed, viewed from all angles, and compared against other data; trends can be discovered and analysed with far greater speed; anomalies and errors can be ferreted out; and the list goes on. There are also many disadvantages, and they’re largely the same things I’d list as advantages!
How can this be?
It depends on who has the data and how they are using it. Do I want an ER doctor to be able to rapidly build a health profile on me while he’s determining how to treat my failing heart? Sure I do! Do I want the state, the federal government, insurance companies, criminals, my neighbor, basically anyone but my healthcare professional to know my entire health history? No. You may want to share your information, but I don’t and won’t; I’d like to keep it as my choice.
For that matter, I don’t want my healthcare professional to have it any old day, either. What if a pharmaceutical company pays him several heaps of money to hand over my data — even blinded, aggregated patient data? For one thing, the doctor shouldn’t do it without my consent! For another, if that data is valuable, and it’s MY data, I want a say — and the money. It’s valuable right? That’s what I keep hearing.
Have you been reading the news for the past few years and seeing the many cases of massive data breaches? Millions of records exposed at any one time? Aha! This wouldn’t happen if my records were on paper in a filing cabinet! And you’d be absolutely correct, but the basic underlying technology of ink and paper versus bits and magnetic storage are not really the issue; they’re beside the point. There are really two problems, as I see it, that make data susceptible to theft: 1) centralization of data, and 2) the people who are handling this data are not computer or security experts, and I don’t think we should expect them to be.
So what am I suggesting?
My suggestion is one that is unlikely to be palatable to many because they will fear it, but i’m not terribly interested in people’s responses; my interest lies in minimizing security risk and ensuring that you are in control of your data. So in addition to some sort of standard of data and data exchange, I’d be in favor of rules and regulations about retention and visibility data between parties (i.e., you and your doctor) that primarily make you the guardian of your own data. I know this sounds scary. Print off your data if you like. Back it up in some encrypted format in some faraway place. By all means maintain the safety of your information, but also by all means YOU maintain the safety of YOUR information.
Afraid yet? So let’s look at some scenarios.
When the government mandates all centralized electronic medical records and our neither-computer-scientist-nor-security-expert federal employee somehow lets hundreds of millions records loose in the wild, how many people are affected? I think I already said it! Hundreds of millions. Do you even have a copy of this record? What does it even say about you? Do you know if your information was exposed or not?
Now let’s see what happens when you lose your fully encrypted electronic fob/doohickey in the parking lot at the grocery store. How many people are affected? Just one, and likely only zero: since it’s encrypted and unreadable to anyone else and you have likely printed it out and kept it in a fire safe, or have a duplicate encrypted fob in a fire safe as well, and possibly pay $5 per month to some service to store your information in encrypted form somewhere else (and while i’m dreaming, the cost of the storage is tax-deductible since this whole electronic migration was federally mandated and they are nice guys).
You may ask, “Well, smarty pants, how do I share the info with my doctor if the data is encrypted?” Suffice it to say there are numerous real, present-day security mechanisms that work just fine for this, things like public-key sharing (which I use daily). But dont be distracted from the main point: who is responsible for your information anyway?
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I’ll admit it: I don’t like getting shots.
Not as a kid. Not as a United States Marine. Not even when I worked in hospital administration, and the hospital employee health nurse Sheila would visit my office with her annual reminder that it was time to line up for a preventive dose of the flu. I simply shook my head and declined (more or less) politely.
But this time around, things are a bit different because this year we’re battling a flu that’s something more — more troublesome, more worrisome, more scary — than the seasonal variety that I was willing to risk. This year we’re dealing with H1N1, a virulent, deadly strain of the influenza virus. It’s highly contagious and already widespread — abnormally so for this time of year — in many parts of the U.S. So even though my former job didn’t put me into daily contact with patients, if I were still working in the hospital, or in any other clinical setting, I’d suck it up. I’d roll up my sleeve and take the shot. It’s the only sensible thing to do.
Health care workers, I know some of you are taking offense at being told by your employers that H1N1 vaccinations are mandatory. But there are three very simple reasons to get the shot that outweigh any argument against it.
1. Do it for yourself.
2. Do it for your patients.
3. Do it for the people who care about you and depend on you.
The H1N1 virus is no joke. Even if you question the efficacy of the vaccine or feel your civil rights are being violated or just plain don’t like needles, the fact is your chance of contracting the flu is exponentially diminished if you have been vaccinated. And if you don’t catch it, you can’t spread it.
So yes, this year, even if you think you don’t want to and unless there’s a medical reason why you can’t, get a flu shot. You’ll be glad you did. Plus, Sheila would be proud.
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