Letter to the Editor: A perspective on the PCEHR
I am a Medical Officer at Peel Health Campus in Western Australia. This is a small regional hospital servicing the Peel region, which is south of Perth, around Mandurah.
I write regarding the article entitled "Defining the Role of the Personally Controlled Electronic Health Record" by A/Prof Charlie Corke in Pulse+IT Issue 21, page 8.
Data security is of paramount importance. It trumps ease-of-access, availability, the ability to share it and determines how it is recorded and stored. This is because, given the chance, there are many people out there who will seek to compromise that security and use any and all information they find for their own personal gain, often to the detriment of others. Electronic medical records kept on a secure server somewhere within the health network, in a building under lock and key provide much more security than, say, putting your personal information on your iPhone. Speaking of iPhones, any user who has wanted to do something with their device other than what Apple has prescribed will have eventually figured out that if you conduct a Google search, you can easily find a program to 'jailbreak' your iPhone. 'Jailbreaking' is the process of using a 3rd party program to remove any proprietary security restrictions put in place by the manufacturer. When the iPhone's OS4 (the latest major operating system update) came out, a jailbreaking program was available within weeks on the Internet. This is just one example of how electronic device security systems can be overcome if these devices are distributed out into the community. It allows those inclined to break any security algorithms in place and alter or edit the data as they wish. Furthermore, once those people get better at doing so, they can release easy-access programs for those not so tech-savvy to be able to edit the information on their devices with minimal effort.
I was therefore intrigued that the prospect of giving patients the control of their medical record was seriously being proposed. Any health practitioner who has ever encountered a patient who is less than 100% honest should realise the potential for abuse this idea poses! Patients carrying their own electronic chip around with them, with the idea being that contains a comprehensive record that practitioners may use to assess the patient and determine further management, is frightening. Imagine, if you will, the prescription shopper with their own Personally Controlled Electronic Health Record (PCEHR). They may be able to jailbreak their own PCEHR to fraudulently list things like 'Chronic Back Pain' in their past medical history, or insert a history of reasonable use of benzodiazepines, for which they 'just need another script because they couldn't get an appointment with their regular GP'. GPs (or other specialists) may be tricked into prescribing controlled substances for people whom they would otherwise have been sceptical of. This is just one example of the multitude of ways such a record could be abused.
I fully understand the 24% of Australians who are against and strongly against electronic health records, and privacy advocates who express concern for the security of centralised medical records. The idea that health-care providers who have not seen the patient being able to access their records is understandably unpalatable for many people. However, the idea that people carry around their own PCEHRs is a dangerous one.
I would put forward an alternative suggestion. To help with this I would like to look at another industry which deals extremely valuable parts of everyone's lives; Banks. Banks keep our money in a centralised vault (or database) and while you may visit any branch, your money is always accessible to you via your bank card and PIN. Why should health records by any less secure than peoples' life savings?
To combine the benefits of centralised medical records, with the security and the patient's choice on who to share their information with, why not arm the patients with a Key? This key could be uniquely matched to a patient's medical record so as to only allow access when that key is used. A patient's record could be kept in a centralised database in a concise and comprehensive form, but only be accessible to a practitioner after a patient authorises them with their key. This key could be in the form of an electronic chip, similar to a mobile phone's SIM card, or in the form of a PIN as the banks use. Using this format, it would be much harder for people in the community to 'hack' their own, or others', health records. The health records would be kept safe in a centralised, secure database under lock and key, and patients' wishes for privacy would be respected by restricting access to those records to only those providers with whom they have a therapeutic relationship, via the patient's key.
I believe that centralised, appropriately secured, electronic medical records are a necessity in this electronic age, and any delays in achieving this reality will only result in higher cost to government and the population, in money and more importantly in health.
- CSC Health Care Research Report – A Rising Tide of Expectations. Australian consumers' views on electronic health records. http://www.csc.com/au/insights/51406-csc_health_report_a_rising_tide_of_expectations
- Policy Position eHealth Data and Health Identifiers. August 2009. Australian Privacy Foundation. http://www.privacy .org.au/Papers/eHealth-Policy-090828.pdf
Posted in Australian eHealth