Privacy Dimensions of Medical Record Keeping

by Willis H. Ware

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This paper briefly reviews medical privacy and gives explicit definitions of confidentiality, privacy, and security. It indicates a need to make organizations accountable for the use of personal medical data. It then divides medical information systems into those that support healthcare facility operations, those that support physicians and other healthcare providers, and those that support patient records; privacy and security problems are usually different for each. The paper suggests remedial actions that would improve medical privacy, and discusses relevance of the Privacy Act's Code of Fair Information Practices to medical systems. It concludes with five specific suggestions for action by Department of Health and Human Services (DHHS): establish medical information as confidential by law; include security and privacy as explicit design goals in system procurements; establish legitimate uses for medical data; restrict the scope and time-extent of patient authorizations; create a Code of Fair Medical Information Practices; reconsider the regulations on computer matching of databases.

This report is part of the RAND Corporation Paper series. The paper was a product of the RAND Corporation from 1948 to 2003 that captured speeches, memorials, and derivative research, usually prepared on authors' own time and meant to be the scholarly or scientific contribution of individual authors to their professional fields. Papers were less formal than reports and did not require rigorous peer review.

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