Up for debate: HIT and patient privacy

This month's Wall Street Journal's "Big Issues" feature focuses on healthcare, including information technology and privacy of patient data. The debate-style articles feature first-person arguments by experts on two issues: unique ID numbers for medical records and physician-patient email conversations.

Unique patient identifiers

Proponents say universal patient identifiers (UPIs) are the most efficient way to connect patients to their medical data, according to one article, and that they not only facilitate information sharing among doctors and guard against needless medical errors, but also may offer a safety advantage in that health records would never again need to be stored alongside financial data such as Social Security numbers.

"Lacking an easy, uniform way to identify patients and link them to their health data, doctors, hospitals, pharmacies, insurance plans and others throughout health care have created a sea of unrelated patient-identity numbers that are bogging down our medical-records system," says Michael F. Collins, a board-certified physician in internal medicine and chancellor of the University of Massachusetts Medical School in Worcester, Mass., who argues in favor of unique patient identifiers.

But privacy advocates say information from medical records already is routinely collected and sold for commercial gain without patient consent and that a health-care ID system would only encourage more of the same, according to the article. "The result, they say, will be more patients losing trust in the system and hiding things from their doctors, resulting in a deterioration in care. They agree that it's crucial to move medical records into the digital age. But they say it can be done without resorting to universal health IDs."

Deborah C. Peel, a psychiatrist and health-privacy expert in Austin, Texas, is the founder of Patient Privacy Rights and leader of the bipartisan Coalition for Patient Privacy. She argues against UPIs. A "universal health ID system would empower government and corporations to exploit the single biggest flaw in health-care technology today: Patients can't control who sees, uses and sells their sensitive health data," she writes.

"Searching for sensitive patient information would take just one number, not dozens of account numbers at professional offices, hospitals, pharmacies, labs, treatment facilities, government agencies and health plans. UPIs would make it vastly easier for government, corporations and others to use the nation's health information for their own gain without patients even knowing it."

Readers can weigh in on the debate by casting online votes. At the time this article was published, 62 percent of respondents said patients should have unique electronic identification numbers for their medical records.

Email communication

Should doctors and patients communication via email? That's the second question up for debate in the WSJ.

Despite the fact that email has become commonplace, its use for communications between doctors and their patients remains controversial, the article notes.

"Opponents worry that doctors can't read patients by reading their emails. Important signals can be missed, they say, when doctors can't see their patients' facial expressions, hear the tone of their voices or take note of their body language, and care can suffer as a result. They're also concerned about the security of email communications, as well as doctors' potential liability for the content and results of email exchanges," according to the article.

But proponents say email is a valuable tool in building a relationship between doctor and patient, makes doctors more accessible, and allows a more thorough exchange of information than office visits and phone calls alone. "The security and liability risks, they say, can be managed, and shouldn't be allowed to stand in the way of providing an important service for patients," the article notes.

Arguing in favor of physician-patient emails, Joseph Kvedar, MD, founder and director of the Center for Connected Health in Boston, says the practice helps build better relationships and is good for business. And, he adds, privacy concerns are overblown.

"Sure, privacy is a problem with email. But it's a problem with any communications system. Phone conversations can be overheard, patients' paper files can be misplaced or left exposed to the view of people who shouldn't see them, and so on. Emails can also end up in the wrong hands or be read by the wrong eyes," he writes.

"Privacy can be protected to a great degree by encryption of email messages or by the use of secure messaging applications that are often a feature of a patient portal or the electronic medical-records systems offered by physicians and hospitals."

Sam Bierstock, MD, founder and president of Champions in Healthcare, a healthcare IT consulting group in Delray Beach, Fla., argues against the practice.

Although he concedes that email can be useful for basic patient-doctor communications, such as appointment scheduling and prescription refills, he adds that it's no way to practice medicine.

"Providing care includes an ability to interpret body language, facial expressions and other silent forms of communication that allow doctors to assess patient reactions to information about their health (apprehension, fear, anxiety) and the accuracy of their responses to questions. Online communications eliminate the ability to interpret these important signals. People also generally are more glib and careless in email interactions than they are in face-to-face meetings, again possibly masking their true condition," he writes.

At the time this article was published, more than 80 percent of readers who responded to the online poll said physicians should use email to communicate with patients.

To learn more:
- read the complete Big Issues: Health Care report
- read the UPI debate
- read the physician-patient email debate 

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