Privacy issues surrounding electronic patient records VALL Workshop, Thursday March Christine Marton and Jean-Francois Blanchette, SLAIS, UBC

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1 Privacy issues surrounding electronic patient records VALL Workshop, Thursday March Christine Marton and Jean-Francois Blanchette,

2 Slide 2 Traditional patient record Goals of the patient record Accurately reflect the course of disease Indicate the possible cause of disease (Hippocrates, 5th century BC) Support patient care Legal report of medical actions Support research Healthcare management and services

3 Slide 3 Traditional patient record Components of print records record of health and disease diagnostic-therapeutic cycle Patient report, test results, HCP diagnosis, treatment plan format: alphanumeric data + images order: time-oriented, source-oriented, problem-oriented

4 Slide 4 Traditional patient record Advantages of print records portable freedom in reporting style no special training required no down time (unlike computers & computer networks)

5 Slide 5 Traditional patient record Disadvantages of print records fixed location free-text contents: variable order; illegible; incomplete; ambiguous transcription errors passive

6 Slide 6 Trends towards electronic patient records increase in accessing medical specialists community-based services versus institutional care move to regional health boards and integrated care public desire to be involved in healthcare decision making mobility of Canadian population government desire for increased accountability for health care $$ increased use and availability of computers and Internet access user friendly interface design for medical information systems

7 Slide 7 Functions of electronic patient records same as print patient records decision support quality assessment

8 Slide 8 Advantages of electronic patient records simultaneous access from multiple locations legibility variety of views on data support of structured data entry decision support support of other data analysis electronic data exchange and sharing care support

9 Slide 9 Disadvantages of electronic patient records implementation is expensive and lengthy loss or corruption of data security concerns privacy (context dependent: genetics, psychiatry, cardiovascular are key areas of concern)

10 Slide 10 Current Initiatives

11 Slide 11 Current Initiatives

12 Slide 12 Current Initiatives

13 Slide 13 Current Initiatives

14 Importance of privacy Privacy is at the heart of liberty in a modern state Former Justice LaForest, Supreme Court of Canada The interests of society include the privacy of individuals. When privacy is lost, the individual feels it, of course, but society is the real loser. George Radwanski, Privacy Commissioner of Canada That whatsoever you shall see or hear of the lives of men and women which is not fitting to be spoken, you will keep inviolably secret. Hippocratic oath Slide 14

15 Slide 15 Coverage of privacy issues in press Concerns over privacy legislation Concerns over handling of electronic patient records

16 Slide 16 Access to electronic health records health care professionals Physicians, nurses, lab technicians, Occupational, physical, and respiratory therapists Dietitians, pharmacists, optometrists, podiatrists, dentists Psychologists, psychiatrists, social workers government departments and agencies insurance companies

17 Slide 17 Privacy Commissioner of Canada Privacy Act Personal Information Protection and Electronic Documents Act

18 Slide 18 Canadian Medical Association Health Information Privacy Code 1998

19 Slide 19 British Columbia Medical Association

20 Slide 20 Canadian Institutes of Health Research

21 Slide 21 The electronic security paradox In theory, modern mathematical techniques can provide us with levels of electronic security and privacy greater than anything possible in the paper-and-ink world. In practice, electronic security is a (large-scale) disaster waiting to happen.

22 Slide 22 The failed promise Security in a networked world is incredibly complex Electronic security is a chain, no stronger than its weakest link Companies rely on proprietary technologies Organizations are reluctant to publicize their failures: no collective learning process The field has been dominated by sophisticated theory

23 Slide 23 Crypto in the field Why Johnny Can t Encrypt : given a simple encryption task, 1/4 people broadcast the confidential ; 1/4 their decryption key! (Tygar and White 2001) The operation of cryptographic systems requires military precision Infrastructures must be perfectly compatible PKI market has been set to explode for the last 5 years

24 Accessing cryptographic keys Passwords and PINs (what you know): The promise: low-cost, easy to replace The reality: secure passwords are those you can t remember Smartcards (what you have): The promise: are immune to material breach The reality: by fiddling with their power supply, one can obtain information about the keys they contain Slide 24

25 Slide 25 Accessing cryptographic keys Biometrics (what you are): The promise: you can t fake your biological characteristics The reality: anybody can create a fingerprint facsimile with 20$ worth of drugstore goods

26 From written to elec. records If you are trying to get rid of paper because you want to be modern, you will fail (Harper and Selen 2002) because paper is intimately tied to the way people organize their work, individually and collectively. Electronic documents are not eliminating paper, but rather, both are synergized. We have yet to develop the social conventions to deal effectively with this new world. Slide 26

27 From memory to written record [Written] documents did not immediately inspire trust. As with other innovations in technology, there was a long and complex period of evolution before methods of production were developed which proved acceptable. People had to be persuaded that documentary proof was a sufficient improvement on existing methods to merit the extra expense and mastery of novel techniques which it demanded. (Clanchy 1993) Slide 27

28 Slide 28 Further reading Health Canada Office of the Health Information Highway

29 Slide 29 Further reading Canadian Healthcare Technology

30 Slide 30 Further reading Hospital News

31 Slide 31 Further reading Journal of the American Medical Informatics Association

32 Slide 32 Further reading PubMed MEDLINE bibliographic database of health and medical literature

33 Slide 33 Further reading Gale Group databases

34 Further reading University of Ottawa technology law litigation clinic Maintaining a legally sound health record html University C.A. MacDonald & Associates Areas of Expertise Health Information Privacy Clinical Research Institute of Montreal Centre for Bioethics Telehealth Ethics Programme Slide 34

35 The End All images from Hemera The Big Box of Art Questions, comments, concerns Contact us at SLAIS Slide 35

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