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Database Nation by Simson Garfinkel

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Computerized Patient Records: the threat

Physicians are less sanguine about the potential threat to privacy that computerized patient records will bring. According to the Harris-Equifax 1993 survey, 74% of physicians thought that computerized systems were "almost certain to weaken" medical confidentiality, compared to 26% who thought that computers "could be managed to strengthen confidentiality."

The problem is the inherent difference between the physical and the electronic. Paper records are physical. Paper records can only exist in one place at one time. And while paper records can be faxed all over town, a person must be physically holding the records in order to do so.

The principal advantage of electronic records is that they are easy to manipulate, but this ease cuts both ways. With electronic laboratory records, it's unlikely that the results of a patient's last blood test will be lost. That's good for patients—especially patients who don't like getting stuck with needles. But computerized record systems make it equally likely that a curious nurse or intern might walk up to an unattended terminal, type in a name, and see the results of that person's test. And since that same computerized file can be accessed at hundreds of terminals throughout a hospital at the same time, controls are all the more difficult.

In its 1997 report on medical records privacy issues, the National Research Council identified the following five "threat levels" for information stored in healthcare computers: ...

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