Online medical records versus privacy

BANDUNG (JP): In the past two years, I have had my throat checked by doctors eight times. Most times I had severe pain in my throat, perhaps due to my failure to properly protect myself against hazardous chemicals.

My work environment demands that priority be given to the safety of workers, but my glasses for shortsightedness makes me hesitant to use the bulky protective mask supplied to cover my face.

I never go to the same doctor. I used to check out doctors who gave cheap medicine and promised a speedy recovery. The downside was the doctor always asked me the same boring questions. A lot of valuable time was wasted with questions such as "how old you are", "are you allergic to any medications", "what medicine did you last take", or "do you have hypertension". My classic answers were "maybe" or "don't know", answers that a doctor would probably consider unsatisfactory.

Then after the doctor examined my throat and nose, it would be my turn to ask him/her about my condition and the medicines to be prescribed. Most doctors would not answer my pointed questions, except to advise me to take a lot of rest and eat many fruits and vegetables to speed up the process of recovery, another answer I would find unsatisfactory, of course.

Here is one possible scenario: It's 3 a.m. and an unconscious man is rushed to the emergency room. Little is known about the patient, no relative or family accompanied him. His medical records are not available.

What action should the doctors take?

Online medical records could possibly improve the quality of health care and cut its costs by giving doctors and their staff instant information on the patient.

Access to medical records in the middle of the night from institutions all over the world would be very helpful. That is the vision of PersonalMD.com (http://www.personalmd.com), a Californian company which has launched a free online medical- records service.

The company hopes to persuade and encourage doctors and patients to replace paperwork on medical information about patients' medical histories with digital files that can be accessed anytime, anywhere.

PersonalMd lets you create a personal medical dossier on the Web to access in an emergency situation, or even when you make a routine visit to a doctor's office.

Doctors and patients are encouraged to put necessary and important medical data into a patient's private webpage, such as what medication a patient is on, digitized Electro Cardio Graph (EKG), Magnetic Resonance Imaging (MRI) and X-ray images.

When you sign up for this free service, you get a medical card that directs a doctor to a website or a fax-back service where medical staff not connected to the Internet can access your medical records.

Medical staff must enter your password (either found on the card or by asking a patient for a pin number) and enter the doctor's license number before opening your medical records. Thus any doctor who has checked your medical records can be traced.

Whether the average person will enter sensitive personal information remains to be seen. But if successful, online medical records perhaps could rapidly change the doctor-patient relationship. It is increasingly common for patients to share the same medical records as doctors when researching medical treatment. Soon physicians may be asked to share information that patients have a right to review but in practice rarely request.

From a practical standpoint, we have to recognize that some patients who did not grow up in the Internet world will not immediately embrace this service. This new service relies mainly on the patients themselves to obtain medical records from doctors and post them on their private webpages on the Net.

Once patients acquire medical records, they can scan and e- mail them to PersonalMD or, if they don't have a scanner, they can fax it directly to a secured fax machine at PersonalMD. PersonalMD staff will convert the documents into a digital file.

Similarly, emergency room doctors and other physicians can send the records via the Net or fax with a patient's prior consent.

PersonalMD is voluntary, but it still raises security, privacy and safety concerns for many people. Any database of medical records can be cracked by hackers or abused by devious people for their own benefit.

Something as simple as incorrect blood types could be fatal if a hacker changed or submitted the wrong information. There is another problem; doctors may fear that patients entering their own information might omit potentially embarrassing but medically important details in fear of their secrets being revealed.

Computerized medical records are vulnerable to misuse and abuse because security is often overlooked. As more records containing more private personal history, identifying information goes online, some analysts worry that the tendency to abuse privacy will grow. Part of the problem is a lack of effort from health care facilities to upgrade security.

Patients could be shocked and outraged to find that privacy can be so easily compromised.

The use of encryption software technology and by imposing controls such as passwords or electronic blocks or "Firewalls" to deny unauthorized users are absolutely necessary. But the problem is not that easily solved. Why? Because there are concerns that encryption is not a strong enough measure. What is strong enough today will most likely not be strong enough tomorrow.

Considering sensitive matters, we should evaluate the risks and benefits associated with using such databases. Protecting the privacy of someone is important, but saving someone's life is more important.

Therefore, supporting the use of this technology, provided there are adequate safeguards to protect patients' privacy, should be encouraged. Technology can actually build a better doctor-patient relationship.

The idea of this service is very interesting. Its application in Indonesia could be promising in that it can improve the awareness of the need for a healthy life.