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40 J.L. Med. & Ethics 394 (2012)
Currents in Contemporary Bioethics: Access to Sensitive Information in Segmented Electronic Health Records

handle is hein.journals/medeth40 and id is 394 raw text is: Cku-r-rent nE Cont orr o U icthS' Access Eo Sensitive Inbratonin Segmente--- d Mark A. Rothstein AboutThis Column Mark A. Rothstein serves as the section editor for Currents in Contem- is the Herbert F Boehi Chair of Law and Med cine and the Director of the Insitute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine in Kentucky. Introduction Spurred on by Medicare and Med- icaid financial incentives, the pros- pect of increased efficiency, and the expectation of improved outcomes, the rate of adoption of electronic health records (EHRs) by health care providers has accelerated since 2009. According to a study by the Centers for Disease Control and Pre- vention published in 2011, 57% of office-based physicians had adopted some type of EHR system.' Many of the EHR systems currently in use lack essential functionality and lag Department of Health and Human Services (HHS) meaningful use requirements.2 Nevertheless, EHR adoption has gained momentum, and it is realistic to contemplate the implementation of a nationwide sys- tem of interoperable, comprehensive, and longitudinal EHRs. EHR systems and networks have significant implications for health information privacy. In the past, health information privacy has been protected mainly by chaos.3 A typi- cal adult patient might have paper records stored in dozens of locations with no way to locate, retrieve, or aggregate the information. Fragmen- tation is disastrous for achieving con- tinuity of care and satisfactory health outcomes, but it enables health pri- vacy by allowing individuals to con- trol access to their health information through compartmentalization. Fur- thermore, under an uncoordinated paper record system, individuals have the ability to reinvent their medical history by simply changing provid- ers and forgetting past episodes of substance abuse, domestic violence, mental illness, sexually transmitted infections, or other sensitive health conditions. In effect, individuals have the ability to control the narrative of their health history. The most promising technol- ogy for protecting privacy in EHRs, known as segmentation, seques- tration, separate management, or E-consent, is characterized by the electronic sorting of sensitive health information into predefined, stan- dardized categories. There has been considerable debate about the tech- nological, clinical, and economic challenges of these techniques, but there has been virtually no discussion about how segmentation would affect the many non-clinical uses of sensi- tive health information. This article reviews the complicated and conten- tious issues involved in wider access to segmented health information, the inadequacy of current laws, and the need to implement wide-ranging privacy policies before any system of segmentation is adopted. Sensitive Health Information and Treatment One of the key privacy challenges is that once health information is entered into an EHR, it never goes away, regardless of whether the infor- mation continues to be medically rel- evant or its degree of sensitivity. Thus, it is possible that despite detailed security protections against unau- thorized access, health privacy could significantly decrease with EHRs because a wide range of health care providers with authorized access to an EHR will be able to view substan- tially more sensitive health informa- Mark A. Rothstein, J.D., is the Herbert F Boehl Chair ofLaw and Medicine and the Director ofthe lntitute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine. JOURNAL OF LAW, MEDICINE & ETHICS 394

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