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Too Much Privacy Is A Health Hazard

Efforts To Keep Medical Records Secret Can Deprive Doctors OfThe Information They Need To Help
You
By Thomas Lee, M.D. I NE'!VSWEEK
From the magazine issue dated Aug 16. 1999

Most patients like what they see on the computer monitor on my desk. There are lists of their medications
and medical problems, laboratory results and reminders to do mammograms. They are impressed that all
the doctors at our hospital work with the same infonnation about them. They are amused that I can check
their test results from a laptop computer on an airplane. But more than a few people find cause to worry
in this cutting-edge system. Co~ld their diagnOSIs of diabetes leak to employers? Insurers? Companies
making products for diabetics? A few years from now, will their genetic codes be flying around the
Internet?
Thes~ are

not paranoid fantasies. Threats to our medical privacy are proliferating as technology speeds
the flow of infonnation--and people are fighting back. Patients are increasingly reluctant to release their
health records, and states are passing laws to r~trict access to them. Unfortunately, these efforts can
backfire. In Maine lawmakers tried earlier this year to bar the release of any infonnation without a
patieru's written censent. The law seemed reasonable at first, but the result was chaos. Doctors caring for
the same patient couldn't compare notes without first seeking pennission. Clinical labs had to stop giving
patients their results over the phone. You couldn't even call a local hospital to find out if a loved one had
been admitted. Confidentiality is a vital component of the trust between patients and physicians, and
protecting it is worth some incOnvenience. But infonnation is the lifeblood of good health care. In short,
privacy can be hazardous to your health.
(

Consider what happens when a doctor writes you a

prescription. If that doctor doesn't Know about every
other drug you're using, the results can be
disastrous. Patients have, died because one doctor
prescribed Viagra for impotence and another
ordered nitroglycerin for angina--a combination
that cause~ dangerous drops in blood pressure.
Fatal reactions have also occurred when patients on
Prozac or Zoloft were given monoamine oxidase
inhibitors (another type of antidepressant). Most
deaths from drug interactions could be prevented by
databases that show every prescription written for a
particular patient. But insurers usually withhold
that infonnation, for fear of offending subscribers.
The result is that physicians have to rely on what
patients remember, or choose to disclose.

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Drug interactions are not the only potential hazard. Suppose a person whose records are on file atone
hospital shows up in the emergency room of another. Even if the records can be transferred, state law may
bar the release of information about mental illness or HN status, forcing the ER physician to fly half
blind. A laceration on a patient with a history of severe depression may warrant more than sutures-'-it
may have been a suicide gesture. Likewise, pneumonia in a patient with HIV requires qifferent tests and
treatments than it would in someone else.
Even when privacy advocates concede that
, doctors need unfettered access to patients' records, most favor
shielding them from HMO administrators. But a responsible health plan can put clinical information to
good use. As part of a "disease management" program, an HMO may use computer software to determine
\
whether patients with a chronic condition, such as asthma or hypertension, are filling their prescriptions
and showing up for appointments. Those who fall behind may get a reminder bymail or phone. These
programs can measurably improve people's health, but patients often miss out on them by refusing to
authorize access to their records. Some plans hesitate even to launch such programs. One MassachUsetts
HMO is now debating whether to send flu-shot reminders to members with HN. The program would
almost surely save lives, but it wouldjust as surely draw criticism as a breach of confidentiality.
I

Privacy advocates are especially wary ofelectroni<: data. Ifwe can't keep tabs on nuclear secrets at Los
Alamos, they ask, how likely are we to keep computerized medical records out of hostile hands? But
electronic record keeping may actually reduce the risk, even while making information more accessible.
No one can tell who has looked at a paper chart, but anyone who opens a secure electronic record leaves a
computerized fingerprint. A psychiatrist at a New England teaching hospital was recently fined for
peeking at an acquaintance's medical records seven times. The bad news is that it was so easy for the
psychiatrist to gain access. The good news is that she was so easily caught.
The real challenge is not just to detect such breaches but to prevent them. The doctors in my network will
soon have to answer a series of questions before opening a patient's computerized record. We'll have to
explain how we're involved in the patient's care, and how long our need for access will continue. And
logging on to our system requires not only a password but also a smart card that generates new access
codes every 30 seconds. Anyone who stole my smart card would also need my password, and vice versa.
These safeguards cost money and time, and doctors will grumble about the extra keystrokes. But with a
little creativity and common sense, we'll find a way to protect privacy while ensuring that doctors have the
information they need to take good care of-people.

Lee is the medical director of Partners Community HealthCare, Inc., the health network started by
Brigham and Women's Hospital and Massachusetts General Hospital.

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8/2112009 11: 12

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