Medical privacy, or health privacy, is the practice of maintaining the security and confidentiality of patient records. It involves both the conversational discretion of health care providers and the security of medical records. The terms can also refer to the physical privacy of patients from other patients and providers while in a medical facility, and to modesty in medical settings. Modern concerns include the degree of disclosure to insurance companies, employers, and other third parties. The advent of electronic medical records (EMR) and patient care management systems (PCMS) have raised new concerns about privacy, balanced with efforts to reduce duplication of services and medical errors.
The Health Insurance Portability and Accountability Act of 1996 is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. It modernized the flow of healthcare information, stipulates how personally identifiable information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and addressed some limitations on healthcare insurance coverage. It generally prohibits healthcare providers and healthcare businesses, called covered entities, from disclosing protected information to anyone other than a patient and the patient's authorized representatives without their consent. With limited exceptions, it does not restrict patients from receiving information about themselves. It does not prohibit patients from voluntarily sharing their health information however they choose, nor does it require confidentiality where a patient discloses medical information to family members, friends, or other individuals not a part of a covered entity.
The terms medical record, health record and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdiction. A medical record includes a variety of types of "notes" entered over time by healthcare professionals, recording observations and administration of drugs and therapies, orders for the administration of drugs and therapies, test results, x-rays, reports, etc. The maintenance of complete and accurate medical records is a requirement of health care providers and is generally enforced as a licensing or certification prerequisite.
An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.
eHealth is a relatively recent healthcare practice supported by electronic processes and communication, dating back to at least 1999. Usage of the term varies as it covers not just "Internet medicine" as it was conceived during that time, but also "virtually everything related to computers and medicine". A study in 2005 found 51 unique definitions. Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health while others use it in the narrower sense of healthcare practice using the Internet. It can also include health applications and links on mobile phones, referred to as mHealth or m-Health.
Clinical audit is a process that has been defined as a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change
A personal health record (PHR) is a health record where health data and other information related to the care of a patient is maintained by the patient. This stands in contrast to the more widely used electronic medical record, which is operated by institutions and contains data entered by clinicians to support insurance claims. The intention of a PHR is to provide a complete and accurate summary of an individual's medical history which is accessible online. The health data on a PHR might include patient-reported outcome data, lab results, and data from devices such as wireless electronic weighing scales or from a smartphone.
Health technology is defined by the World Health Organization as the "application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of lives". This includes pharmaceuticals, devices, procedures, and organizational systems used in the healthcare industry, as well as computer-supported information systems. In the United States, these technologies involve standardized physical objects, as well as traditional and designed social means and methods to treat or care for patients.
Database security concerns the use of a broad range of information security controls to protect databases against compromises of their confidentiality, integrity and availability. It involves various types or categories of controls, such as technical, procedural/administrative and physical.
Protected health information (PHI) under U.S. law is any information about health status, provision of health care, or payment for health care that is created or collected by a Covered Entity, and can be linked to a specific individual. This is interpreted rather broadly and includes any part of a patient's medical record or payment history.
Secure messaging is a server-based approach to protect sensitive data when sent beyond the corporate borders, and it provides compliance with industry regulations such as HIPAA, GLBA and SOX. Advantages over classical secure e-mail are that confidential and authenticated exchanges can be started immediately by any internet user worldwide since there is no requirement to install any software nor to obtain or to distribute cryptographic keys beforehand. Secure messages provide non-repudiation as the recipients are personally identified and transactions are logged by the secure email platform.
Digital self-defense is the use of self-defense strategies by Internet users to ensure digital security; that is to say, the protection of confidential personal electronic information. Internet security software provides initial protection by setting up a firewall, as well as scanning computers for malware, viruses, Trojan horses, worms and spyware. However information at most risk includes personal details such as birthdates, phone numbers, bank account, schooling details, sexuality, religious affiliations, email addresses and passwords. This information is often openly revealed in social networking sites, leaving Internet users vulnerable to social engineering and possibly Internet crime. Mobile devices, especially those with Wi-Fi, allow this information to be shared inadvertently.
Clinical point of care (POC) is the point in time when clinicians deliver healthcare products and services to patients at the time of care.
Medical device connectivity is the establishment and maintenance of a connection through which data is transferred between a medical device, such as a patient monitor, and an information system. The term is used interchangeably with biomedical device connectivity or biomedical device integration. By eliminating the need for manual data entry, potential benefits include faster and more frequent data updates, diminished human error, and improved workflow efficiency.
In Electronic Health Records (EHR’s) data masking, or controlled access, is the process of concealing patient health data from certain healthcare providers. Patients have the right to request the masking of their personal information, making it inaccessible to any physician, or a particular physician, unless a specific reason is provided. Data masking is also performed by healthcare agencies to restrict the amount of information that can be accessed by external bodies such as researchers, health insurance agencies and unauthorised individuals. It is a method used to protect patients’ sensitive information so that privacy and confidentiality are less of a concern. Techniques used to alter information within a patient’s EHR include data encryption, obfuscation, hashing, exclusion and perturbation.
Health care analytics is the health care analysis activities that can be undertaken as a result of data collected from four areas within healthcare; claims and cost data, pharmaceutical and research and development (R&D) data, clinical data, and patient behavior and sentiment data (patient behaviors and preferences,. Health care analytics is a growing industry in the United States, expected to grow to more than $31 billion by 2022. The industry focuses on the areas of clinical analysis, financial analysis, supply chain analysis, as well as marketing, fraud and HR analysis.
Medical data, including patients' identity information, health status, disease diagnosis and treatment, and biogenetic information, not only involve patients' privacy but also have a special sensitivity and important value, which may bring physical and mental distress and property loss to patients and even negatively affect social stability and national security once leaked. However, the development and application of medical AI must rely on a large amount of medical data for algorithm training, and the larger and more diverse the amount of data, the more accurate the results of its analysis and prediction will be. However, the application of big data technologies such as data collection, analysis and processing, cloud storage, and information sharing has increased the risk of data leakage. In the United States, the rate of such breaches has increased over time, with 176 million records breached by the end of 2017. There have been 245 data breaches of 10,000 or more records, 68 breaches of the healthcare data of 100,000 or more individuals, 25 breaches that affected more than half a million individuals, and 10 breaches of the personal and protected health information of more than 1 million individuals.
Data re-identification or de-anonymization is the practice of matching anonymous data with publicly available information, or auxiliary data, in order to discover the individual to which the data belong. This is a concern because companies with privacy policies, health care providers, and financial institutions may release the data they collect after the data has gone through the de-identification process.
Federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of electronic health records. The US Congress included a formula of both incentives and penalties for EMR/EHR adoption versus continued use of paper records as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the, American Recovery and Reinvestment Act of 2009.
My Health Record (MHR) is the national digital health record platform for Australia, and is managed by the Australian Digital Health Agency. It was originally established as the Personally Controlled Electronic Health Record (PCEHR), a shared electronic health summary set up by the Australian government with implementation overseen by the National Electronic Health Transition Authority (NEHTA). The purpose of the MHR is to provide a secure electronic summary of people's medical history which will eventually include information such as current medications, adverse drug reactions, allergies and immunisation history in an easily accessible format. This MHR is stored in a network of connected systems with the ability to improve the sharing of information amongst health care providers to improve patient outcomes no matter where in Australia a patient presents for treatment. PCEHR was an opt-in system with a unique individual healthcare identifier (IHI) being assigned to participants and the option of masking and limiting information available for viewing controlled by the patient or a nominated representative; MHR uses an opt-out system.
