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Letter to the Editor: Medical Privacy

by Sharon Bryant
Saturday, January 22, 2000

The true privacy of our medical records may soon be a thing of the past. The Clinton Administration has announced new rules to protect medical privacy and streamline data transfer of medical records. The President's justification for creating these regulations is "administrative simplification of health care billing, research, national security and law enforcement". These new rules are known as "Administrative Simplification" and are an amendment of the Health Insurance and Portability Act of 1996 and were published in the November 4, 1999 Federal Register. They can be read on the web at www.aspe.hhs.gov/adminsimp.

The proposed rules include giving every American a "Unique Health Identifier" which would be permanently attached to all medical records. A national database, using the Unique Health Identifier will then be created to aid in research, national security, and policy development. The anonymity of medical information will be lost, as data will be linked to our personal Identifier. Considering that the government once promised that Social Security Numbers would be used for tax purposes only, can we really believe that Unique Health Identifiers will be used for medical reasons only?

The regulations also allow private and government agencies-including banks, police departments, the FBI, OSHA, and the Environmental Protection Agency to view your medical records without your consent. In fact, you won't even be notified when your medical records are shared.

These regulations create the illusion of protecting our privacy, when in fact they remove the safeguards for sharing medical records. For example, no warrant would be necessary for police to access your medical records and there would no longer a requirement for judicial review. Police would actually be able to retrieve large numbers of medical records to browse for blood type or DNA matches. Administrative Simplification allows the release of medical information for national security purposes, including categories such as "all those receiving mental health services' at a given clinic, or all persons being treated for AIDS in a region.

The release of such broad categories of medical records to law enforcement, or to a government database will destroy any confidence patients have in their health care providers. The regulations themselves actually state that "government data are notoriously susceptible to expansion and abuse". Some patients may choose to lie about their health practices, or avoid treatment.

Personal identifiers, national databases, and carte blanche access by public and private agencies are poor strategies for protecting patient records. Health information must remain confidential and accessible only to providers and payers-with the patient's written consent. The law already allows police to access information with probable cause and a warrant. We now collect health data for research without identifiers. Call your legislators and let them know that Administrative Simplification is an unwarranted and dangerous invasion of our privacy.

Sharon Bryant can be reached at sbryant@freeway.net

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