Seeking Confidentiality of Medical Records.

• Author: KLOSS, LINDA L.

EVERY AMERICAN, from the beginning of life to its end, enjoys a ndamental, but not absolute, right to privacy that is deeply rooted in both tradition and law. In no area is this right more cherished, or more unsettled, than in protecting the confidentiality of identifiable personal health information, as lawmakers, judges, and health care professionals struggle to balance individual privacy interests against other strong societal concerns.

Personal health information is maintained not only by physicians, but in the records and/or databases of hospitals and clinics that provide treatment or diagnostic services, laboratories that perform tests, pharmacies, and insurance companies and managed care organizations to which claims are submitted or that provide coverage. In addition, personal health data frequently is shared with universities and pharmaceutical companies for research purposes.

Certain medical information, by law, must be reported to state and local governments, where it is maintained in databases. For instance, U.S. jurisdictions typically require the reporting of venereal disease to public health agencies, of child abuse to child welfare agencies, and of injuries caused by firearms to law enforcement agencies.

The flow of medical information carries numerous personal and societal benefits. The ability to access medical records has saved the lives of unconscious patients brought into hospital emergency rooms. Pharmacists have detected dangerous, sometimes potentially lethal, drug combinations. In the public health arena, computerized records have made possible the prompt detection of infectious disease epidemics and enabled health authorities to take emergency action. Researchers have used databases to analyze the causes of illnesses, a process that, for example, established the connection between smoking and lung cancer. On the other hand, the vast accumulation of personal medical data gives rise to serious privacy concerns because of the potential for misuse.

Breaches of confidentiality have been widespread. In some instances, they occur within the parameters of present law. Pharmacies in some states legally sell individual prescription records to pharmaceutical companies for use in marketing campaigns.

Other breaches have been illegal. The medical records of a candidate for Congress, indicating that she once had attempted suicide, were sent to the New York Post on the eve of her primary election. A Colorado medical student sold patient records to lawyers soliciting malpractice plaintiffs. In Florida, the names of 4,000 HIV-positive patients was carelessly released to two newspapers.

The collateral social consequences of improper or illegal dissemination of personal health information are far more devastating than solicitations from drug companies and malpractice lawyers. They include the denial of such basic...