In 1818, British author Mary Shelley's Dr. Frankenstein, creating the infamous tale frightened and seduced appeal. Just as the macabre, but resourceful, doctor created life from non-life, which terrorized the local countryside, we have a "cyber-created monster," the "life" and knows no boundaries. It can not actually terrorize us, but we are also fascinated by him. It deeply influences and impacts on our daily work, but it is out of control and hasproduced many controversial issues related to freedom of expression, censorship, intellectual property and privacy. The free market and society norm may be able to some extent regulate these issues and eventually help allay many of our concerns. An important and controversial concern that requires further discussion, is to maintain the confidentiality of personal medical data.
The expectations of privacy and Medical Information
According to attorney and privacy lawSpecialist, Ronald B. Standler, "Privacy is the expectation that confidential personal information that indicates in a private place will not be disclosed to third parties if such disclosure would cause either embarrassment or emotional distress to a person of reasonable sensitivities" (Standler, 1997) . Another theorist, Ruth Gavison defines privacy as "the restriction of access of other partners, to a person with three key elements: secrecy, anonymity and solitude." Secret or confidentialwith the limits of the exchange of knowledge about themselves. Anonymity treat unwanted attention refers to his solitude, apart from others (Spinello, 2003). Basically, we want the integrity that we protect what we do and what we do. Regardless of our definition, the right to privacy usually refers to persons who are in a place that may give rise to it, a private nature. Information to include the public, or known to the public voluntarily given, is not protected.
The open architecturethe modern phenomenon that we call the Internet raises a very unique ethical concerns about privacy. The information is easily sent through this vast global network without boundaries. Personal data may pass through many different servers on the path to a destination. There are virtually no online activities or services that guarantee absolute privacy. It's easy to think, weigh your activity is private when actually many of these computer systems collectand store this personal data and effectively monitor your online activities (Privacy Rights Clearinghouse, 2006). The net underlying architecture is designed to share information and not to conceal or protect. Although it is possible to develop a reasonable degree of certainty, with an acceptable risk, it is too enormous cost and time.
Medical records are among the types of personal information about a person, and medical history, lifestyle includedDetails (such as smoking or taking part in high-risk sports), test results, medications, allergies, surgeries and procedures, genetic testing and participation in research projects zuständig.ESF protection of this private medical information falls within the field of medical ethics. The field of medical ethics is to analyze and to ethical dilemmas that clarify the medical practice and biomedical research. Medical ethics is guided by strict principles and standards that address: autonomy, beneficence,Harm avoidance, Fidelity, and Justice (Spinello, 2003). The principle of autonomy implies the right of a person, fully informed of all relevant information to his / her health informed. A discussion of the medical and ethical principles of the rights of patients leads us to further legislation to protect and preserve this precious right to discuss.
Access to Private Medical Information Systems and the Health Insurance Portability and Accountability Act of 1996
Since 400 BC and theEstablishment of the Hippocratic Oath, to protect the privacy of patient medical information was an important part of the physician "code of conduct. Unfortunately, many organizations and individuals who are not required by this strict code of conduct more frequent, this private information.Every time a patient a physician sees, he is admitted to a hospital, goes to a pharmacist or sends a claim to a health plan that had a record of their health information confidential. In the past, allHealth care providers protect the confidentiality of medical data by locking them away in file cabinets and refusing to disclose them to other people. Today, we rely on "protected" electronic records and perform a complicated series of laws, our confidential and private medical records.
Congress correctly recognized the need for national patient record privacy standards in 1996, when she, the Health Insurance Portability and Accountability Act adopted HIPAA). This act was effective April14, 2003 (small health plans was the implementation date of 14 April 2004) and was intended to improve the efficiency and effectiveness of healthcare in the country. For the first time, federal law established standards for patient medical record access and privacy in all 50 states. The Act includes provisions that raises money for health care companies through the promotion of saving electronic transactions, but it also required new safeguards to protect the security and confidentiality of that information(Diversified Radiology of Colorado, 2002).
There are three main parts of HIPAA: Privacy, Code Sets, and security. The section "security" into four parts: administrative procedures, physical safeguards, technical security services are divided (the "data at rest") and technical security mechanisms (the "data in transit).
PRIVACY:
To protect the intent of the HIPAA rules for privacy of patients and allow patients greater access to theirmedical records. The law deals specifically protected patient health information (PHI) and the patients better access to and amendment of their medical records. Prior to the provision of outpatient services, the Covered Entity must begin with the patient consent to PHI with such organizations as the insurance billing company, the payroll office will share, and doctors, the patient can be referred. The individual must be able to access their records, request correction ofErrors, and they have, how their personal information is used, to be informed. Individuals are also entitled to file formal privacy-related complaints with the Department of Health and Human Services (HHS) Office for Civil Rights.
Code sets:
Under standardized HIPAA, the codes are to improve the safety and security of health information. Under the new set of standards, a code is a set of codes for encoding data elements such as tables are used, the concepts, medical diagnosis codes,Procedure codes, etc.
SECURITY:
The security section is divided into four main parts:
1. Administrative, formal procedures must be documented to the implementation of security policies and procedures regulating conduct of personnel in the field of data protection, security training, incident-protection procedures, and termination policies.
2. Physical protection measures relating to the protection of physical computer systems, network protection, environmental risks andphysical disturbance. One must look at the computer screen placement, pass code protection and computer locks to control access to medical information.
3. Technical Security Services refers to PHI stored on the computer network and how they are safely stored and retrieved. The use of the PHI must be registered and authenticated. An audit trail of authenticated access will be maintained for 6 years.
4. Technical Security Mechanisms refers to PHI, over a communications networksuch as the Internet, Frame Relay, VPN, Private Line, or another network. PHI, over a communications network must be encrypted.
There are also some significant shortcomings HIPAA. The law did little to actually health insurance more "portable" when an employee changes employers. Also, the law does not significantly increase accountability of health insurance, with provisions for misconduct, which often are difficult to monitor and enforce. There are also a lot of confusionPatients and healthcare providers, relating to the interpretation of the Act (Diversified Radiology of Colorado, 2002).
Other laws, regulations and decisions of private medical information
In addition to HIPAA, there are important state regulations and laws, and federal laws and legal decisions regarding the privacy and confidentiality of medical information (Clifford, 1999):
The Privacy Act of 1974 restricted government agencies sharing of medicalInformation from one agency to another. Congress has declared "the privacy of individuals is directly affected by the collection, maintenance, use and dissemination of personal information ...," and that" the right to privacy is a fundamental human right protected by the Constitution of the United States ... " (Parmet, 2002).
The Alcohol and Drug Abuse Act passed in 1988, is confidentiality for records of patients being treated for alcohol or drug abuse (only if theytreated in institutions that receive federal funding).
The Americans with Disabilities Act went, in 1990, prohibits the employer from the employment in relation to decisions on the basis of a real or perceived disability, including mental retardation. The employer may not always have access to identifiable health risk information about employees at a reasonable business requirements, including the determination of reasonable accommodations for disabled workers and for the treatment of workers compensation claims.
Supreme CourtDecision Jaffee v. Redmond: On 13 June 1996 the Court held that there is a broad federal privilege protecting the confidentiality of communications between psychotherapists and their clients. The decision applies to psychiatrists, psychologists and social workers.
Freedom and Privacy Restoration Act of 1999: Designed to prevent the creation of government unique medical ID numbers.
Managed Care and Online Threats to Private Medical Information
The introduction of theInternet and advances in telecommunications technology over the past two decades, allows us to access large amounts of medical information, regardless of time, distance, or remoteness, with relative ease. This cyber access to medical information has fundamentally changed the way patients and health care providers provide counseling to deal with. There are no more obstacles to the efficient exchange of health information and critical life-saving medical information. In addition to the many advantages of Internet crimeAccess to medical information, there are also serious threats to our privacy and our medical information.
The intense interest in the protection and privacy of medical data is driven by two major developments. The first is the growth of electronic medical records, that has replaced the paper records. A report by the National Academy of Sciences that the healthcare industry spent between $ 10 and $ 15 billion on information technology in 1996 (Mehlman, 1999). Thiswas the year when the Health Insurance Portability and Accountability Act, was passed with most of the spending attributed to the conversion of printed information to electronic patient records formats.Electronic (EMRS) represent a significant threat to maintaining the privacy of patient identifiable medical information. This medical information is immediately by anyone who is available, access and passwords. Although hard copy medical information can easily be copied, electronic records aremuch more easily copied and transferred without borders.
The second important development concerns that the privacy of patient information is the overall growth of managed care organizations. There is a demand for an unprecedented depth and breath of personal medical information by a growing number of players. In contrast to traditional fee-for-service health care providers can care and the insurer, the same company. In this situation, all medical information in the possessionthe supplier is also known to the insurer. This applies to all forms of managed care practice, but most clearly in closed-panel HMOs. The exchange of information increases the fear that the insurer can use the data to limit benefits or terminate insurance (Mehlman, 1999).
Some managed care companies reported private medical information to a supplier in the extreme demand on the case manager within twenty-four hours every case, as a high risk forthe customer a second party, the employer or the managed care companies. Examples include such things as possible danger to themselves or others suspected child abuse, potential threats to national security or the client organization, customer request for records, complaints about services, Employee Assistance Program or the threat of legal action and potential involvement in litigation, including confession or knowledge of criminal activities. Not a word about client privacy or rights in relation to theRelease of this information. Nothing is also said that with the information that is shared should be performed (Clifford, 1999).
Another problem with managed care companies is the large amount of data processed and the carelessness in handling medical information. An outstanding example is concerned with losing records, such as in a 1993 sample survey of the San Francisco Bay Area psychologists. In this survey 59% of the reports by mail or fax to the wrong person, charts were inadvertently switched, or properPermission is not obtained (Clifford, 1999).
Conservation and Protection of Electronic Private Health Information
To conserve and protect valued private medical information, we must always be vigilant and proactive. Getting started can be taken before the use of electronic exchange of information. For example, when signing a "Release of Information", read everything carefully. If not clearly understand, ask questions. Also, remember that HIPAA grants you the right to requestYour health care provider that a restriction of the use or disclosure of your medical information. Make sure those who are properly identified and request the information and the right to collect such information. Finally, make sure that the person used to collect information on at least two "identifiers" for precise identification of patients to ensure (eg name, last four social security, address, phone number, birth date, etc.
When dealing with electronic and computerized medical informationThe situation is getting thinner and more complex. Secure networks and websites, passwords, firewalls and anti-virus software, are unquestionably the first steps in a plan of protection. Passwords must be a complex, pinned with numbers, letters and boxes, but also easy to use. To ensure safety, experts recommend that passwords be changed every 90 days or if they are believed to be questioned. In addition, all private medical information on the Internet or non-secure networks are to be sentencrypted. Encryption (64 or 128 bit) is translating information into a secret code if a key or password is required to read the information.
Further security is provided through the use of privacy enhancing P3P framework, filtering software (eg MIMESweeper), message authentication codes (MACs) and digital signatures. "The Platform for Privacy Preferences Project (P3P) is a technological framework to a range of uses user-defined standards in order to negotiate Web sites, such as theUser information is used and will be disseminated to third parties (Spinello, 2003). The P3P architecture helps to better define and Cyber Ethics, improves accessibility, improves consistency and increases the overall confidence in the with cyberspace. MACs use a shared key generated and verified that a message whereas digital signatures generally two complementary algorithms - one for the signature and the other for testing.
It also has some creative technology for the maintenance of the proposedand the protection of private medical information. In October 2004 the "VeriChip" by the FDA for implantation into the triceps of the patients was approved. The chip is about the size of a grain of rice and is inserted under the skin during a 20-minute procedure. This invisible chip stores a code that can be scanned to further release a patient's private medical information. This code is then used to download encrypted medical data. The procedure costs about $ 150-200 (MSNBC, 2004).
Anothercommonly used medical information is the "smart" card, a credit card sized device with a small embedded computer chip. This "computer in a card" can be programmed to perform tasks and store important information. In an emergency, paramedics and emergency rooms equipped with smart card readers can quickly access potentially life-saving information about a patient, such as allergies, medications and chronic diseases. There are different types of smart cards: memoryCards, cards, electronic purse cards, security cards and Java Cards. These cards are tamper-resistant can be PIN protected or read-write protected, can be encrypted and can be easily updated. These unique properties make smart advantageous for the storage of personal and medical information are popular all over the world. In Germany and Austria, 80 million people have the ability to deal with these smart cards when they visit their doctor (Cagliostro, 1999).
There is also aformer government proposed plan to establish a national system of electronic health records (EHR). Details include the establishment of a National Health Information Network, the electronic medical records for all patients connect to the provider is insured, pharmacies, laboratories and claims processors. The exchange of important information could improve patient care, are more accurate and timely hedging of receivables and a gain for public health in emergency situations. The goal is to be implemented, must be of2009th Even with laudatory goals of saving the money so that medical care is more efficient, and decreasing drug reactions and interactions, there are still risks involved in this national plan. There are legitimate concerns that pharmaceutical companies may try a new drug or device for your specific medical condition market. There are also strong worries of exploitation and abuse of personal data. Who will monitor access to information? There are also concerns that lenders or employers mayrely on private medical information to business decisions. Then there's always the ever-present fear of hackers and jokester retrieve your personal information. There are so many questions unanswered (Consumer Reports.org, 2006).
As a result we are now down to a "cyberspace monster" and all its advantages and shortcomings. When we use cyberspace, we can have no expectation of privacy, and we must accept a degree of risk. Therefore, when transferring and sharingprivate medical information, we must always be aware to take precautions to protect our privacy as much as possible through the use of secure networks into account, P3P architecture, passwords, firewalls, encryption, message codes, digital signatures and equipment such as Smart Cards and VeriChips. " Medical records are among the types of personal information about a person, but we are faced with the challenge of striking a balance between the interests of the Society for the Protection of medical confidentiality and the legitimate need totimely access to important medical information, especially with the fear of influenza pandemics and bioterrorism. If this information is transmitted in an electronic format, we have raised concerns about the care and protection of private data. With managed care, there is a demand for an unprecedented depth and breath of personal medical information by a growing number of players. While the HIPAA regulations are a welcome start to the protection of our private medical information, we mustremain vigilant to protect the ever-increasing demand for this specific information.
References:
Cagliostro, C. (1999) Smart card primer.
Clifford, R. (1999) The confidentiality of records and managed care legal and ethical issues.
Consumer Reports.org (2006). The new threat to your medical privacy.
Diversified Radiology of Colorado (2002) History: HIPAA general information.
Mehlman, MJ (1999) new issues: the privacy of medical records.
MSNBC(2004) FDA approves computer chip for humans.
Parmet, WE (2002) Public health and protection of privacy of medical records.
Privacy Rights Clearinghouse (2006) Internet privacy resources.
Spinello, RA (2003) Cyber Ethics: Morality and law in cyberspace. Jones and Bartlett Publishers, Sudbury, MA
Standler, RB (1997) Privacy Law in the U.S..
No comments:
Post a Comment