Computer Science Illuminated, Third Edition


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HIPAA: Health Insurance Portability and Accountability Act

Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.From the Hippocratic Oath

In 1996, a new law, the Health Insurance Portability and Accountability Act (HIPAA) was introduced to encourage and codify the electronic use and distribution of confidential patient information. The law allows more parties than ever before access to medical records without patient consent. The ability to do so seems to have led to a perceived need to do so. Proponents of the law claim current technology that allows collecting and sharing previously confidential information can help doctors diagnose patients, researchers develop new drugs, and governments track and combat public health threats like the 2003 outbreak of SARS. While admitting that these benefits do exist, opponents claim that unrestricted access to all information contained in medical records is neither necessary nor beneficial. They cite instances of psychiatrists being forced to allow insurance company personnel access to all patient records under threat of being dropped from the insurer’s pool of care providers; hospitals sending entire records to third party billing companies; and health maintenance organizations (HMOs) providing personal information to employers. Each of these activities erodes the privacy Americans once enjoyed related to their medical histories. With a few keystrokes, a marketer can acquire a list of your prescription medications and send you promotional materials, or sell the information to yet another party. A 1993 law allows building databases that include who takes Prozac, who has abortions, and which illnesses individuals have had. All of these data would be available to government agencies and law-enforcement, among others.

Another technological twist on health care is the use of medical identity cards. The plan has been on hold in the United States, but recently took effect in the United Kingdom. Citizens would be assigned cards with magnetic strips. Every time a prescription is filled or a doctor’s office visited, the card is swiped and data is collected. An individual’s entire medical history from birth on would then be available electronically. Another plan in the works would include genetic information, such as the genetic markers for breast cancer and heart disease. You would be subject to having this information follow you regardless of whether you have ever had the actual disease.

Do the benefits of tracking disease and selling drugs more effectively outweigh the benefits of medical privacy? Privacy advocates claim that such "Big Brother" technological applications could have a chilling effect. Knowing that their relationship with their doctors is no longer private, patients might either avoid seeking medical attention, or might not divulge sensitive information, thus reducing the effectiveness of the care they do receive. The battle over the HIPAA provisions continues, and it may be some time before its consequences are fully known. In the mean time, it is a fact of life that medical privacy is a thing of the past.

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