What's more important, privacy or security?

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GHIT Notebook

February 27, 2008

Privacy and security were major concerns at the Healthcare Information and Management Systems Society's big meeting in Orlando, Fla., this week, both in the number of sessions devoted to these themes, and in the underlying message that health care must get these things right if HIT is to prosper.

HIMSS found in its own annual leadership survey of the industry that some 86 percent of its respondents were actively managing security risks, and HIMSS board chair John Wade connected the dots by saying that this showed how the industry was responding to consumer concerns about the privacy of their health information.

It will be interesting to see if they actually are. Deborah Peel, who heads the Patient Privacy Rights advocacy organization, would probably disagree.

Security is important, Peel told an attentive HIMSS audience, because patient data does need to be protected from prying eyes. On the other hand, security doesn't equal privacy, she said.

Privacy comes when it's the patient who controls who gets to see what's in their medical record, something that Peel sees as a long way from the present reality. At the moment, it sometimes seems that it's the patient who is the last to know.

And if a recent survey of state e-health activities conducted on behalf of the National Governors Association is to be believed, there's yet another divide.

States certainly use privacy in the same way that Peel uses the term, but to them it's a barrier to the kind of sharing of health information they believe is necessary for the health information exchanges they are trying to build.

In fact, it's a barrier twice over. The differing consent requirements that are required to release information is the greatest barrier, the survey found. And the second biggest is federal health law.

The emphasis here is on moving consent in the direction of easier information sharing. Certainly not to strip those protections, but nevertheless to do something to make it easier for HIE. Wisconsin recently decided to alter its laws in that direction, and Peel for one was not impressed.

Her group recently formed Privacy Rights Certified, Inc., to give a seal of approval to organizations who offer such things as personal health records, to see if they reach what her outfit considers proper privacy protections. Microsoft's HealthVault will be the first to come under the microscope, within the next 30-60 days.

So, privacy or security, or both? In many ways it's as open a debate as it could be. As Peel herself pointed out, the Department of Health and Human Services doesn't even have a definition for patient privacy yet. And it's an election year, with the mantle of health reformer up for grabs by the candidates.

By Brian Robinson

View Comments

Experts can argue with each other about security and privacy all they want, but from what I can tell, their arguments are irrelevant. Here is the bottom line: If Americans do not trust EHRs, they will opt-out one way or another. If the doctors don’t trust them, they will keep two sets of records.

If this year’s bureaucrats continue to charge recklessly ahead for quick profits, can next year’s president mandate trust? Darrell Pruitt

Posted by darrelldk on February 27, 2008

Re: Deborah Peel's "attentive" audience. What attentive audience? Readers should note that Peel was booked into the 2,643-seat Chapin Auditorium in anticipation, I presume, of a large crowd. Actual attendance was fewer than 500, closer to 200-300. Of these, many wandered out while she was speaking. Not surprising given her poor public speaking skills and lack of preparation.

She is not winning any converts to her cause and I would be very surprised if HIMSS offered her a venue like this the next time around.

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