Public Health Law Map - Beta 5 - Medical and Public Health Law Site

difficult to authenticate, unless the computer entry ports have biosensors, such as
fingerprint or retina scanners. This makes it hard to tell if the correct provider really
entered the data. Electronic records also allow the use of form data such as a canned
review of systems designed to support billing for a given diagnosis. Again, properly
designed records will prevent this, but it will be years before there are adequate
standards and certifications for medical records software.
The fourth problem is privacy. All medical care practitioners know that medical
privacy is more of a myth than a reality. Too many people see records and it is too hard
to secure them to ensure real privacy for any specific record. On balance, however, the
system is fairly secure because the difficulty of retrieving and copying more than a few
records makes large-scale information theft impossible. In an electronic system,
however, a breach in security can mean the theft of all of the data, without even a
warning that it is gone. Given a big enough selection of records and the means to fish
through them electronically, an infovandal could do real harm. This might be in the
form of public embarrassment or humiliation, or in blackmail demands to keep the
information secret.
Medical care practitioners who use electronic records systems must ensure that the
records are secure. This means both electronic security and physical security—many
serious breaches of computer security can be traced to passwords and operating
information that was retrieved from dumpsters or stolen by cleaning staff. In many
offices the easiest way to steal the data is to just walk out with a backup tape. The
requirements for proper computer security are beyond the scope of this book. Any
office that uses electronic records must work with a computer security expert to ensure
that the system is secure. It is important to not just take the word of the vendor, but to
get an independent evaluation of both the system and the general security in the
offices.
F. References - Medical Records
Barrows RC Jr, Clayton PD. Privacy, confidentiality, and electronic medical records. J
Am Med Inform Assoc. 1996;3:139–148.
Barton HM. Medical records can win or lose a malpractice case. Tex Med. 1990;86:33–
36.
Berlin L. Alteration of medical records. AJR. 1997;168:1405– 1408.
Burton K. Your memory/your patient’s memory and your medical records. WV Med J.
1996;92:308–309.
Butler RN. Who’s reading your medical records? Geriatrics. 1997;52:7–8.
Campbell SG, Gibby GL, Collingwood S. The Internet and electronic transmission of
medical records. J Clin Monit. 1997;13:325–334.
Carman D, Britten N. Confidentiality of medical records: the patient’s perspective. Br
J Gen Pract. 1995;45:485–488.
378