[LINK] Electronic medical records: why we should seek a second opinion

[Stephen Wilson]

On 19/12/2011 3:30 PM, David Boxall wrote:
>  Those of us who are more comfortable will quibble about privacy and
>  such ...

Comfortable?  Quibble?  I'd prefer to say that whose who are equipped to 
think through the privacy issues will demand serious attention to 
privacy and security.

I smell a rat when a writer like Dr Ahned opens the privacy analysis by 
saying yes there are risks but the benefits are greater.  Who says?  
Where's the risk analysis (or is it just guesswork)?  What exactly -are- 
the risks?  Who understands them?

And I smell a whole rats nest when the supposed benchmark for acceptable 
risk is Internet banking.  Internet banking is still relatively new, and 
the relative risk changes almost on a monthly basis.  There is no 
benchmark by which the public really understands and accepts the risks.  
There is famously little transparent discussion of Internet banking 
risks.  As a community we're still playing with this tech, and proper 
security measures are still evolving.

But even more importantly when it comes to extrapolating to e-health:

Firstly, Internet banking security is purely an economic proposition.  
It's all about whether the losses from data breaches are less than the 
savings.  Is this frame applicable to e-health?

And secondly, while stolen money is reasily returned, health information 
and privacy are not.  It is quite inappropriate to base e-health risk 
analysis on the net banking experience, much less to base e-health 
security solutions on banking tools.

Cheers,

Stephen Wilson
Managing Director
Lockstep Group

Phone +61 (0)414 488 851

http://lockstep.com.au <http://www.lockstep.com.au>
Lockstep Consulting provides independent specialist advice and analysis
on digital identity and privacy.Lockstep Technologies develops unique
new smart ID solutions that enhance privacy and prevent identity theft.



>  From:
> 
<http://www.smh.com.au/opinion/politics/electronic-medical-records-why-we-should-seek-a-second-opinion-20111218-1p0o3.html>
>
>
>
December 19, 2011
>  Dr Tanveer Ahmed
>
>  There are fears that the US's overreach in Iraq and Afghanistan, in
>  combination with its tenuous financial state, may spell the end of
>  its global hegemony. But the superpower's downfall is just as likely
>  to be caused by the cost of MRI scans as it is by defence spending.
>
>  Health remains the greatest non-security challenge Western
>  governments face. The task of managing an ageing population, whizbang
>  technologies and a demanding public is awesome.
>
>  Australia is not quite in the budget quagmire on health, but there is
>  every chance its proportion of gross domestic product costs will
>  continue to rise above the current 10 per cent. One of the great
>  potential contributors to efficiency in what is notoriously the most
>  inefficient of sectors is the electronic patient record. By allowing
>  for more efficient sharing of information, health records stored as a
>  transferable entity in digital form could transform the entire
>  sector. Advertisement: Story continues below
>
>  The electronics and computing revolutions of the past several decades
>  have reshaped much of medicine, giving us advanced imaging
>  techniques, microchips for monitoring and regulating heart function,
>  and countless new diagnostic tools.
>
>  But the information infrastructure of healthcare lags behind. Patient
>  records and the data needed for determining effective medical
>  practice remain decidedly low-tech.
>
>  Every week I have frustrating conversations with colleagues who
>  refuse to use email for correspondence about patients, instead
>  directing me to send them a fax.
>
>  As a junior doctor, I spent countless hours looking for forms,
>  patient files and important X-rays. I wasn't alone, as a 2001 study
>  by management consultants in Britain confirmed that medical officers
>  there spent an hour a day looking for data instead of applying their
>  scarce skills.
>
>  Just about every other industry - financial services, travel,
>  entertainment, communication, you name it - has been radically remade
>  by information technology in the past two decades. But not
>  healthcare.
>
>  Entrepreneurs have harnessed science and technology to make dramatic
>  advances in the practice of medicine but the health information
>  system remains archaic and paper-bound. This paradox gets to the
>  heart of why healthcare is simultaneously so impressive and so
>  frustrating. The opportunity cost of inaccessible and unused data is
>  particularly high for the millions of Australians suffering from
>  conditions such as diabetes, mental illness and heart disease. This
>  type of chronic disease increasingly forms the bulk of sickness and
>  relies on team co-ordination to deliver high-quality care.
>
>  Such sufferers would benefit enormously from regular, systematic
>  analyses of their condition based on automated reviews of their key
>  health indicators. It would also save taxpayers billions of dollars.
>
>  One of the key concerns from consumers is about the privacy and
>  security of the data. This is a particular concern among mental
>  health sufferers who worry that sensitive information will become
>  available to other health providers or even employers. But we have
>  been willing to accept some risk to our privacy in exchange for
>  convenience in the wide use of the internet banking, shopping and
>  other services involving personal information. If patients could make
>  greater use of the internet to improve their interactions with their
>  doctors, they would quickly see the benefits and accept the risk,
>  knowing there are appropriate safeguards.
>
>  The government's plan to introduce the electronic patient record is
>  on a tight schedule with the rollout to begin in July. The push will
>  almost certainly need to come from consumers and governments, given
>  such investments in technology do not produce a financial return for
>  doctors and hospitals.
>
>  The main beneficiaries are the patients who will gain new and more
>  convenient access to their medical records and the healthcare system
>  at large, which will operate more efficiently. The physicians and
>  hospital administrators stand to lose their monopoly control over
>  clinical information and get paid nothing more for their efforts.
>
>  Indeed, many experts believe it will reduce demand for doctors and
>  cut hospital admissions, as better information improves prevention
>  and discourages the ineffective use of medical services.
>
>  But there is a real risk that democratisation may go too far, with
>  plans to give greater powers to consumers to alter their own records
>  without medical input, which instil understandable fear in both
>  doctors and their insurers.
>
>  Equivalent attempts have fallen over in Britain due to a combination
>  of financial turmoil, a change of government and poor clinician
>  involvement. Our government has learnt from these mistakes but the
>  risk remains that the issue may not be given due weight by the
>  community. Its appearance seems to be limited to the IT sections of
>  newspapers. But it could be a transformative event, for it will limit
>  the potential of future health expenses to strain our economy, and it
>  will make us healthier.
>