Computerizing medical files may threaten personal privacy But task force says it slashes costs

May 06, 1993|By Knight-Ridder News Service

WASHINGTON -- The drive for national health care reform is likely to cost you more than money; it may threaten your personal privacy as well.

To battle surging health care costs, doctors, hospitals and druggists are rapidly turning to computers, building massive electronic databases containing the most intimate details about your body and your life.

Computerized medical records promise better care at lower cost. But they increase the risk of exposing such sensitive matters as drug and alcohol abuse, emotional distress, abortions or sexual problems.

If those data fall into the wrong hands, they could not only embarrass you but also hurt your chances of getting a job or a mortgage, renting an apartment or buying insurance.

Dr. Tom Reardan of Portland, Ore., a trustee of the American Medical Association, said protecting confidentiality is "the biggest issue" facing the rush to computerize health records.

"Once you put it onto a computer, you know that anyone who can write software can access it," Dr. Reardan said.

President Clinton's task force on health care reform is determined to computerize the health care system to save money. But task force members are concerned about privacy and favor national legislation to ensure it.

"Collecting this information will save the country billions of dollars in the long run, but we are going to protect citizens' rights," said Robert Boorstin, a task force spokesman. "We would never want to sacrifice privacy."

Ironically, there are laws protecting the privacy of your credit rating, your driving record, even your video rentals -- but no federal law covers your medical records unless you are an AIDS patient.

An entire industry has sprouted to collect, package and resell health care information to drug makers, insurance companies, lawyers and employers.

For example, a brochure published by Medco Containment Services, the nation's biggest mail-order prescription service, boasts about its computerized drug utilization program, MedScan.

"MedScan records all drugs dispensed through the plan to maintain a detailed claims history on each patient," the brochure says. A Medco subsidiary, Medical Marketing Group, then sells the customers' prescription records to drug makers.

Health information brokers say they delete individual names from the files before reselling them, but this is purely voluntary.

"Prescription records can easily be matched with voter-registration or motor vehicle files to gather addresses and phone numbers," said Rep. Pete Stark, D-Calif. "These records can be -- and have been -- sold to employers" who may fire or refuse to hire a person with health problems, he said.

Employers' use of medical records to screen job applicants or decide who gets promoted or laid off is an especially sensitive issue.

Half the companies in America check medical records in making employment decisions, according to a 1989 study by David Linowes, an authority on privacy at the University of Illinois. A 1991 survey by the congressional Office of Technology Assessment found that many companies refuse to hire people with a pre-existing medical condition.

"Say a supervisor wants to decide which of two employees to promote," said Mark Rothstein, a legal scholar at the University of Houston. "He checks their personnel files. One man has epilepsy or kidney disease. He doesn't get the promotion."

Advocates of computerizing medical records contend that sensitive information can be protected from intruders by requiring secret passwords or encrypting the data. Opponents reply that every such system has been broken by clever "hackers" or electronically sophisticated private detectives.

"There is no example of a large computer system that has not been subject to massive abuse," said Robert Gellman, a congressional staff lawyer who specializes in privacy matters.

While computerization would magnify the danger, paper records are already being misused.

Rep. Nydia M. Velazquez, D-N.Y., for example, was running for Congress last year when someone anonymously faxed her hospital records, containing potentially damaging information, to New York newspapers and TV stations. Impacto, a small Spanish-language newspaper supporting her opponent, ran the story, and then the New York Post, a flamboyant tabloid, bannered it.

Ms. Velazquez demanded a criminal investigation, but no law protected her privacy. "Yes, those records are mine," she said at a news conference. "But the real question is this: What kind of people would send them to newspapers?"

Said Pamela K. Wear, an adviser on health records to the Clinton task force, "Consumers in America have to trust the system or we're not going anywhere."

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